Carpal Tunnel Syndrome (CTS) is the utmost common compressive central mono-neuropathy seen in medical practice, accounting for 90% of all neuropathies. Carpal tunnel syndrome presents in 3.8% of the overall population, with a higher prevalence among women. There are many risk factors related to CTS, including both medical and non-medical factors. The pathophysiologic mechanisms involved in the median nerve compression and traction are thought to be complicated, and up to now don’t seem to be totally understood. This review aimed to provide an overview of the pathophysiology of median nerve neuropathy in the carpal tunnel, and subsequent development of CTS along with their diagnostic tools and treatment.
Cite this article:
Pratik D. Gadkari, Girish D. Dahikar, Rajendra O. Ganjiwale. A Review on Carpal Tunnel Syndrome. Research J. Pharm. and Tech. 2020; 13(10):4961-4965. doi: 10.5958/0974-360X.2020.00870.7
Pratik D. Gadkari, Girish D. Dahikar, Rajendra O. Ganjiwale. A Review on Carpal Tunnel Syndrome. Research J. Pharm. and Tech. 2020; 13(10):4961-4965. doi: 10.5958/0974-360X.2020.00870.7 Available on: https://rjptonline.org/AbstractView.aspx?PID=2020-13-10-73
1. Aroori S, Spence RA. Carpal Tunnel Syndrome. The Ulster Medical Journal. 2008;77:6-17.
2. Cranford CS, Ho JY, Kalainov DM, Hartigan BJ. Carpal tunnel syndrome. J Am Acad Orthop Surg. 2007;15:537-48.
3. Mackinnon SE, Dellon AL. Surgery of the peripheral nerve. New York: Thieme Medical Publishers. 1988:146-69.
4. Ghasemi-Rad M, Nosair E, Vegh A, Mohammadi A, Akkad A, Lesha E. A handy review of carpal tunnel syndrome: From anatomy to diagnosis and treatment. World Journal of Radiology. 2014;6(6):284-300.
5. Kasundra GM, Sood I, Bhargava AN, Bhushan B, Rana K, Jangid H, et al. Carpal tunnel syndrome: Analyzing efficacy and utility of clinical tests and various diagnostic modalities. Journal of Neurosciences in Rural Practice. 2015;6:504-10.
6. Ali Z, Khan A, Shah SMA, Zafar A. Clinical and electro-diagnostic quantification of the severity of carpal tunnel syndrome. Ann Pak Inst Med Sci. 2012;8(4): 207-12.
7. Mizia E, Iskra T, Musiał A, Matuszyk A, Tomaszewski KA. Carpal tunnel syndrome—anatomical and clinical correlations. Folia Medica Cracoviensia. 2013.
8. Alfonso C, Jann S, Massa R, Torreggiani A. Diagnosis, treatment and follow-up of the carpal tunnel syndrome: a review. Neurological Sciences. 2010;31(3):243–52.
9. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282(2):153–8.
10. Ibrahim I. carpal tunnel syndrome: A review of the recent literature. The Open Orthopaedics Journal. 2012;6(1):69–76.
11. Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". Wiki Journal of Medicine.1(2). DOI:10.15347/wjm/ 2014.010. ISSN 2002-4436.
12. Rodner C, Raissis A, Akelman E: Carpal tunnel syndrome. Orthopaedic Knowledge Online Journal. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2009; 7(5). Accessed March 2016
13. Poisel S. ursprung und Verlauf des Ramus muscularis des Nervus digitalis palmaris communis I (N. medianus). Chir Praxis. 1974; 18: 471–474.
14. Lanz U. Anatomical variations of the median nerve in the carpal tunnel. The Journal of Hand Surgery. 1977; 2(1): 44–53.
15. Barbe M, Bradfield J, Donathan M, Elmaleh J. Coexistence of multiple anomalies in the carpal tunnel. Clinical Anatomy: The Official Journal of the American Association of Clinical Anatomists and the British Association of Clinical Anatomists. 2005; 18: 251–259.
16. Tountas CP, Bhrle DM, Mac Donald CJ, Bergman RA. Variations of the median nerve in the carpal. The Journal of Hand Surgery. 1987; 12: 708–712.
17. Hurwitz PJ. Variation in the course of the thenar motor branch of the median nerve. The Journal of Hand Surgery. 1996; 21B: 344–346.
18. Kozin SH. The anatomy of the recurrent branch of the median nerve. The Journal of Hand Surgery. 1998; 23A: 852–858.
19. Cavallo AV, Slattery PG, Barton RJ. Endoscopic carpal tunnel release and congenital anomalies of the median nerve. Hand Surgery. 2003; 8(2): 265–270.
20. Mizia E, Klimek-Piotrowska W, Walocha J, Rutowski R, Wojtala R. The median nerve in the carpal tunnel. Folia Morphologica. 2011; 70(1): 41–46.
21. Mizia E, Gziut T, Kruk S, Golec E, Walocha J. Anomalous course of thenar motor branch of the median nerve — a case report. Kwart Ortopaedics. 2012; 2: 270–273.
22. Mizia E, Tomaszewski KA, Goncerz G, Depukat P, Walocha J. The importance of ulnar side approach in carpal tunnel syndrome surgical treatment — anatomic variations of the median nerve and surrounding structures. J Orthop Trauma Surg Rel Res. 2012; 4: 19–24.
23. Mizia E, Tomaszewski KA, Goncerz G, Kurzydło W, Walocha J. Median nerve thenar motor branch anatomical variations. Folia Morphologica. 2012; 71(3): 183–186.
24. Zamborsky R, Kokavec M, Simko L, Bohac M. Carpal tunnel syndrome: symptoms, causes and treatment options. Literature review. Ortop Traumatol Rehabil. 2017 Jan 26;19(1):1-8.
25. Uchiyama S, Itsubo T, Nakamura K, Kato H, Yasutomi T, Momose T. Current concepts of carpal tunnel syndrome: pathophysiology, treatment, and evaluation. Journal of Orthopaedic Science. 2010;15(1):1–13.
26. Perkins BA, Olaleye D, Bril V. Carpal tunnel syndrome in patients with diabetic polyneuropathy. Diabetes Care. 2002;25(3): 565–9.
27. Makepeace A, Davis WA, Bruce DG, Davis TME. Incidence and determinants of carpal tunnel decompression surgery in type 2 diabetes: the Fremantle Diabetes Study. Diabetes Care. 2008;31(3):498–500.
28. Hakim AJ, Cherkas L, El Zayat S, MacGregor AJ, Spector TD. The genetic contribution to carpal tunnel syndrome in women: a twin study. Arthritis Care and Research. 2002; 47: 275–279.
29. Kopeć J, Gadek A, Drożdż M, Miśkowiec K, Dutka J, Sydor A, Chowaniec E, Sułowicz W. Carpal tunnel syndrome in hemodialysis patients as a dialysis-related amyloidosis manifestation-incidence, risk factors and results of surgical treatment. Medical science monitor: international medical journal of experimental and clinical research. 2011; 17(9): CR505–509.
30. De Krom MC, Knipschild PG, Kester AD, Spaans F. Efficacy of provocative tests for diagnosis of carpal tunnel syndrome. The Lancet. 1990;335(8686):393–5.
31. Werner RA, Andary M. Carpal tunnel syndrome: pathophysiology and clinical neurophysiology. Clinical Neurophysiology. 2002; 113(9):1373–81.
32. Marshall SC, Tardif G, Ashworth NL. Local corticosteroid injection for carpal tunnel syndrome. In The Cochrane Collaboration, editor. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley and Sons, Ltd; 2007.
33. Wong MWN, Tang YN, Fu SC, Lee KM, Chan KM. Triamcinolone suppresses human tenocyte cellular activity and collagen synthesis. Clinical Orthopaedics and Related Research®. 2004;(421):277–81.
34. Gerritsen AAM, De Krom MCTFM, Struijs MA, Scholten RJPM, De Vet HCW, Bouter LM. Conservative treatment options for carpal tunnel syndrome: a systematic review of randomised controlled trials. Journal of Neurology. 2002;249(3):272–80.
35. Stark H, Amirfeyz R. Cochrane corner: local corticosteroid injection for carpal tunnel syndrome. Journal of Hand Surgery (European Volume). 2013;38(8):911–4.
36. Sevim S, Dogu O, Camdeviren H, et al. Long-term effectiveness of steroid injections and splinting in mild and moderate carpal tunnel syndrome. Neurological Sciences. 2004;25(2):48–52.
37. Kruger VL, Kraft GH, Deitz JC, Ameis A, Polissar L. Carpal tunnel syndrome: objective measures and splint use. Archives of physical medicine and rehabilitation.1991;72(7):517–20.
38. Kim PT, Lee HJ, Kim TG, Jeon I-H. Current approaches for carpal tunnel syndrome. Clinics in Orthopedic Surgery. 2014;6(3):253–7.
39. Johns Hopkins Medicine. Treatments, Tests and Therapies. Carpal Tunnel Release. Available from: URL: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/carpal-tunnel-release
40. Zuo D, Zhou Z, Wang H, et al. Endoscopic versus open carpal tunnel release for idiopathic carpal tunnel syndrome: a meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research. 2015;10(1):12.
41. Chow JC. Endoscopic release of the carpal ligament: A new technique for carpal tunnel syndrome. Arthroscopy: The Journal of Arthroscopic and Related Surgery. 1989;5(1):19–24.