Skip to main content
SpringerLink
Log in

Carpal Tunnel Syndrome

  • Chapter
  • First Online:
Disorders of the Hand

  • 1835 Accesses

Abstract

Carpal tunnel syndrome (CTS) is a collection of symptoms and signs arising from compression and/or traction on the median nerve at the level of the carpal tunnel. It is a common condition, with a prevalence of 3.8 % in a healthy population and is probably on the increase, related to an increasing mean Body Mass Index (BMI) [1, 2]. It is the commonest nerve compression syndrome and is therefore of great interest to health purchasers and providers alike. The response to the financial burden of treating carpal tunnel syndrome has been varied throughout the UK. In some areas carpal tunnel release (CTR) has been designated as an operation that requires exceptional funding, whilst in other areas it is available on a one stop clinic basis. The 2013 tariff for CTR is between £900 and £1,250 and it is likely to be one of the conditions that is very appealing to healthcare providers, in that it is usually simple to diagnose and straightforward to treat [3]. CTS is a clinical diagnosis, requiring assessment by a clinician with sufficient experience to filter out those patients that need investigation of an alternative cause of their symptoms. There is concern that the oversimplification of the treatment pathway, if there is no assessment by a hand surgeon, may lead to problems such that some patients may undergo unnecessary or unsuccessful CTR surgery before it is established that CTS is an incorrect diagnosis. Also the operation, though usually straightforward, is not without complications which can, on rare occasions, be catastrophic.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Atroshi I, et al. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282(2):153–8.

    Article  CAS  PubMed  Google Scholar 

  2. Geoghegan JM, Clark DI, Bainbridge LC, Smith C, Hubbard R. Risk factors in carpal tunnel syndrome. J Hand Surg Br. 2004;29(4):315–20.

    Article  CAS  PubMed  Google Scholar 

  3. UK Payment by Results. http://www.dh.gov.uk/health/2012/02/confirmation-pbr-arrangements/.

  4. Gelberman RH, Hergenroeder PT, Hargens AR, Lundborg GN, Akeson WH. The carpal tunnel syndrome: a study of carpal canal pressures. J Bone Joint Surg Am. 1981;63(3):380–3.

    CAS  PubMed  Google Scholar 

  5. Nakamichi K, Tachibana S. Restricted motion of the median nerve in carpal tunnel syndrome. J Hand Surg Br. 1995;20(4):460–4.

    Article  CAS  PubMed  Google Scholar 

  6. Farmer JE, Davis TR. Carpal tunnel syndrome: a case-control study evaluating its relationship with body mass index and hand and wrist measurements. J Hand Surg Eur Vol. 2008;33(4):445–8.

    Article  CAS  PubMed  Google Scholar 

  7. Chen CH, Wu T, Sun JS, Lin WH, Chen CY. Unusual causes of carpal tunnel syndrome: space occupying lesions. J Hand Surg Eur Vol. 2012;37(1):14–9.

    Article  PubMed  Google Scholar 

  8. Phalen GS. The carpal-tunnel syndrome: seventeen years’ experience in diagnosis and treatment of six hundred fifty four hands. J Bone Joint Surg Am. 1966;48(2):211–28.

    CAS  PubMed  Google Scholar 

  9. Page MJ, O’Connor D, Pitt V, Massy-Westropp N. Therapeutic ultrasound for carpal tunnel syndrome. Cochrane Database Syst Rev. 2012;1:CD009601. doi: 10.1002/14651858.CD009601.

  10. O’Connor D, Marshall SC. Massy-Westropp N, Pitt V. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev. 2003;(1):CD003219. doi: 10.1002/14651858.CD003219.

  11. Marshall SC, Tardif G, Ashworth NL. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev. 2007;(2):CD001554. doi: 10.1002/14651858.CD001554.pub2.

  12. Verdugo RJ, Salinas RA, Castillo JL, Cea JG. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev. 2008;(4):CD001552. doi: 10.1002/14651858.CD001552.pub2.

  13. Braithwaite BD, Robinson GJ, Burge PD. Haemostasis during carpal tunnel release under local anaesthesia: a controlled comparison of a tourniquet and adrenaline infiltration. J Hand Surg Br. 1993;18(2):184–6.

    Article  CAS  PubMed  Google Scholar 

  14. Kaplan EB. Surface anatomy of the hand and wrist. In: Spinner E, editor. Functional and surgical anatomy of the hand. Philadelphia: J.B. Lippincott Co; 1953. p. 227–31.

    Google Scholar 

  15. Lanz U. Anatomical variations of the median nerve in the carpal tunnel. J Hand Surg Am. 1977;2(1):44–53.

    Article  CAS  PubMed  Google Scholar 

  16. Ting J, Weiland AJ. Role of ancillary procedures in surgical management of carpal tunnel syndrome: epineurotomy, internal neurolysis, tenosynovectomy, and tendon transfers. Hand Clin. 2002;18:315–23.

    Article  PubMed  Google Scholar 

  17. Cook AC, Szabo RM, Birkholz SW, King EF. Early mobilization following carpal tunnel release: a prospective randomized study. J Hand Surg Br. 1995;20(2):228–30.

    Article  CAS  PubMed  Google Scholar 

  18. Isaac SM, Okoro T, Danial I, Wildin C. Does wrist immobilization following open carpal tunnel release improve functional outcome? A literature review. Curr Rev Musculoskelet Med. 2010;3:11–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Saw NLB, Jones S, Shepstone L, Meyer M, Chapman PG, Logan AM. Early outcome and cost-effectiveness of endoscopic versus open carpal tunnel release: a randomized prospective trial. J Hand Surg Br. 2003;28(5):444–9.

    Article  CAS  PubMed  Google Scholar 

  20. Pensy RA, Burke FD, Bradley MJ, Dubin NH, Wilgis EFS. A 6-year outcome of patients who cancelled carpal tunnel surgery. J Hand Surg Eur Vol. 2011;36(8):642–7.

    Article  CAS  PubMed  Google Scholar 

  21. Nancolllas MP, Peimer CA, Wheeler DR, Sherwin FS. Long term results of carpal tunnel release. J Hand Surg Br. 1995;20(4):470–4.

    Article  Google Scholar 

  22. MacDonald R, Lichtman D, Hanlon J, Wilson J. Complications of surgical release for carpal tunnel syndrome. J Hand Surg Am. 1978;3:70–6.

    Article  CAS  PubMed  Google Scholar 

  23. Palmar AK, Toivenon DA. Complications of endoscopic and open carpal tunnel release. J Hand Surg Am. 1999;24:561–5.

    Article  Google Scholar 

  24. Stust N, Gohritz A, Van Schoonhoven J, Lanz U. Revision surgery after carpal tunnel release – analysis of the pathology in 200 cases during a 2 year period. J Hand Surg Eur Vol. 2006;31(1):68–71.

    Google Scholar 

  25. Taghizadeh R, et al. The role of MRI in the diagnosis of recurrent/persistant carpal tunnel syndrome: a radiological and intra-operative correlation. J Hand Surg Eur Vol. 2011;64(9):1250–2.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Hand Surgery, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Windmill Road, Headington, Oxford, OX3 7LD, UK

    Ian S. H. McNab MB BS, FRCS (Orth)

  2. Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK

    Sarah Tucker MB ChB, Msc(Clin Ed), FRCS(Plas)

Authors
  1. Ian S. H. McNab MB BS, FRCS (Orth)
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarah Tucker MB ChB, Msc(Clin Ed), FRCS(Plas)
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ian S. H. McNab MB BS, FRCS (Orth) .

Editor information

Editors and Affiliations

  1. Wrightington Hospital, Wigan, United Kingdom

    Ian A. Trail

  2. St George's Hospital, London, United Kingdom

    Andrew N.M. Fleming

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag London

About this chapter

Cite this chapter

McNab, I.S.H., Tucker, S. (2015). Carpal Tunnel Syndrome. In: Trail, I., Fleming, A. (eds) Disorders of the Hand. Springer, London. https://doi.org/10.1007/978-1-4471-6560-6_12

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-6560-6_12

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-6559-0

  • Online ISBN: 978-1-4471-6560-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation