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Median nerve compression at the wrist resulting in Carpal tunnel syndrome is the most common peripheral nerve entrapment neuropathy. Patients will report tingling and numbness in the thumb index and middle fingers, difficulty manipulating small objects, aching around the wrist and a tendency to drop things. Night time symptoms of tingling disturb sleep and frequently numbness persists on waking. The loss of fine motor control is due to loss of sensory feedback as well as median-innervated intrinsic muscle weakness and the loss of thumb opposition. Clinical examination will confirm the diagnosis and neurophysiological tests may be used to confirm the diagnosis, provide a severity of grading or help in diagnosis in challenging or atypical presentation.
Open surgical decompression of the Carpal tunnel remains the gold standard although mini-open and endoscopic Carpal tunnel decompression have become popular in an attempt to reduce scar sensitivity following surgery and shorten return to work. Limited exposure techniques convey a higher risk of iatrogenic nerve injury. I use a traditional open approach in my practice.
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