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Carpal tunnel syndrome
What's new
Updated 2024 AAFP guidelines for the management of carpal tunnel syndrome .
Background
Overview
Definition
CTS is condition characterized by symptomatic compressive neuropathy of the median nerve at the wrist.
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Pathophysiology
CTS is caused by compression and traction of the median nerve in the carpal tunnel, either due to idiopathic causes or secondary to fibrous hypertrophy of synovial flexor sheath or due to repetitive movements of the wrist.
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Epidemiology
The prevalence and incidence of CTS in the United State are 7.8% and 2.3 per 100 person-years, respectively.
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Disease course
The combination of increased pressure in the tunnel, median nerve microcirculation injury, median nerve connective tissue compression, and synovial tissue hypertrophy results in altered function of the nerve, demyelination, and degeneration of the nerve at the site of compression and beyond. These events cause paresthesias, weakness, and loss of function in the distal distribution of median nerve (thumb, index, middle finger, and the radial side of the ring finger) and even outside the distribution of the median nerve.
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Prognosis and risk of recurrence
Carpal tunnel release is effective in 70-90% of the patients. The recurrence rate after carpal tunnel release varies from 3-25%.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of carpal tunnel syndrome are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2024,2016), the American Academy of Orthopaedic Surgeons (AAOS/ASSH 2024), the American College of Radiology (ACR 2024), the American Society of Interventional Pain Physicians (ASIPP/NASS/AAPM/ASRA/IPSIS 2024), the Academy of Orthopaedic Physical ...
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