Carpal tunnel syndrome (CTS) is a multifactorial neuropathy
caused by compression of the median nerve at the carpal tunnel. Its symptoms
include pain, tingling or numbness affecting mainly the thumb, index and middle
finger (sometimes the ring finger is also involved), with this sensation that
could travel up the arm; hand weakness (mainly the thumb’s pinching muscles).
Symptoms may vary in characteristics and severity and can be confound with
other upper arm neuropathies and radiculopathies.
The diagnosis is made with accurate history taking and
clinical examination, supported by electromyography (EMG) and nerve conduction
studies.
Most people with mild to moderate symptoms are initially
treated non-operatively. However, surgery is thought to provide more effective
and durable symptom relief, especially for the most severe cases.
CTS is becoming more common, as is its surgical management.
This constitutes a significant economic burden for societies. All surgical
techniques have provided satisfactory results and have been proven to be effective
options. After reviewing the most up to date literature, it could be said that
evidence of superiority of one technique over the others is lacking from a high
level of evidence point of view. Specific advantages and disadvantages of
surgical methods can, however, be taken into account when choosing among
treatments. The simple algorithm of leaving the choice of the surgical method
to surgeons’ preference and experience (together with consideration of
patients’ related factors) seem to be the best available option, which is
supported by the most recent metanalysis and systematic reviews.
Research towards a universally accepted standardization
should be aimed for by the authors, who have failed to date to sufficiently
limit bias and limitations.
Author(s) Details:
Valerio Pace,
Trauma and Orthopaedic Surgery Consultant, AOSP Terni, Italy.
Daniele Sticchi,
Trauma and
Orthopaedic Surgery Resident, University of Perugia, Italy.
Giacomo Placella,
Department of Trauma and Orthopaedics, IRCSS San Raffaele Hospital,
Milan, Italy.
Please see the link here: https://stm.bookpi.org/NVMMS-V7/article/view/14228
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