J Korean Orthop Assoc.  2014 Oct;49(5):331-339. 10.4055/jkoa.2014.49.5.331.

Carpal Tunnel Syndrome

• Lee SH
• Lee SJ

• KMID: 2185168
• DOI: http://doi.org/10.4055/jkoa.2014.49.5.331

Abstract

Carpal tunnel syndrome is the most common peripheral nerve entrapment syndrome. The elevated pressure in the carpal tunnel causes compression of median nerve. Although the diagnostic criteria for carpal tunnel syndrome are not clear, the diagnosis is based on the patient history and physical examination and may be confirmed by electrodiagnosis with nerve conduction test or ultrasonography. Nonsurgical treatments are generally recommended for early carpal tunnel syndrome and surgical treatments are preferred for failed nonsurgical treatment, however there is controversy regarding the optimal time when the surgery should be performed. Results of surgical treatment are usually satisfactory, however there are also complications after surgical treatment. In order to achieve good results without complications, normal anatomy around the median nerve and its anatomical variations should be thoroughly understood before the operation and careful surgical technique is absolutely required.

Keyword

carpal tunnel syndrome; median nerve

MeSH Terms

Carpal Tunnel Syndrome*
Diagnosis
Electrodiagnosis
Humans
Median Nerve
Neural Conduction
Peripheral Nerves
Physical Examination
Ultrasonography

Figure

• 

  Figure 1 Ultrasonography of carpal tunnel shows a persistent median artery (solid arrow) and bifid median nerve (doted arrows).

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  Figure 2 Anatomic variations of median nerve. 1. Usual branching of the median nerve; 2. Thenar branch leaving the median nerve within the carpal tunnel (subligamentous); 3. Transligamentous course of the thenar branch; 4. Thenar branch leaving median nerve at its ulnar aspect; 5. Thenar branch crosses over the top of the transverse carpal ligament; 6. Doubled thenar motor branch. Data from the article of Lanz (J Hand Surg Am. 1977;2:44-53).3)

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  Figure 3 Kaplan cardinal line and anatomic landmarks. Dashed line is standard palmar incision and the solid arrow is the point that the recurrent motor branch of the median nerve usually enters the thenar muscles. K, Kaplan line; H, hamate hook; PL, palmaris longus; FCR, flexor carpi radialis.

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  Figure 4 Katz and Stirrat hand diagram.19) (A) Classic pattern. Symptoms affect at least two of digits 1, 2, or 3. The classic pattern permits symptoms in the fourth and fifth digits, wrist pain, and radiation of pain proximal to the wrist, but it does not allow symptoms on the palm or dorsum of the hand. (B) Probable pattern. Same symptom pattern as classic, except palmar symptoms are allowed unless confined solely to the ulnar aspect. In the possible pattern (not shown), symptoms involve only one of digits 1, 2, or 3. (C) Unlikely pattern. No symptoms are present in digits 1, 2, or 3.

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