Carpal tunnel syndrome is the most common compression neuropathy in the upper limb. Symptoms and signs are caused by compression of the median nerve in the carpal tunnel at the wrist.

There are many factors implicated in median nerve compression in the carpal tunnel, and carpal tunnel syndrome can often result from one or a combination of any.

While a genetic predisposition or trauma may lead to the development of carpal tunnel syndrome, other causes include (but are not limited to) diabetes mellitus, rheumatoid arthritis, hypothryoidism, pregnancy, tenosynovitis of the flexor tendons, accessory muscles, a ganglion cyst or tumour.

Carpal tunnel syndrome typically presents with sensory symptoms in the median nerve distribution of the hand. Such symptoms may include numbness, tingling and paraesthesia; and typically occur at night.

Motor symptoms may also develop in advanced disease and include weakness in certain muscles of the hand which may lead to loss of grip strength, difficulty forming a fist, and inability to grasp large objects.

Carpal tunnel syndrome is a clinical diagnosis, however electrodiagnostic tests may be used for confirmation and determination of the severity of nerve compression.

Treatment of symptoms in early disease includes activity modification, splinting of the wrist in a neutral position at night and nonsteroidal anti-inflammatory drugs (NSAIDs). Corticosteroid injections are used with varying degrees of success, and may be recommended by Dr Tolerton in certain diagnostic and therapeutic situations.

Surgical treatment of carpal tunnel syndrome is one of the most common surgical procedures performed by hand surgeons. Various techniques of releasing the carpal tunnel (and thus median nerve) have been described. The two main techniques being open or endoscopic (keyhole). Both of which can be performed in the operating theatre under local anaesthesia.