Carpal Tunnel Syndrome

Abstract

Carpal tunnel syndrome (CTS) is the most common form of peripheral entrapment neuropathy (accounts for 90 % of all entrapment neuropathies) and is one of the prevalent etiologies of hand morbidity. Therefore, an early diagnosis is important to prevent permanent nerve damage and functional sequelae. CTS diagnosis is usually based on the combination of clinical symptoms (pain, numbness, nocturnal paresthesia, and burning) in the median nerve distribution, signs such as Tinel, Phalen, and carpal tunnel (CT) compression tests, as well as nerve conduction studies. Earlier works revealed that the clinical signs are moderately sensitive and specific, whereas false-negative and false-positive results have been reported with nerve conduction studies. Over the past decade, ultrasonography (US) has emerged as a simple, feasible, rapid, accurate, and noninvasive imaging tool for evaluating the median nerve in the CT. Not only it is able to detect changes in the nerve shape but also excludes anatomic variants and space occupying lesions such as tenosynovitis and ganglion cysts. Furthermore, US permits perception of nerve compression characteristics in relation to time and severity. This chapter aims to provide an overview of the use of US in CTS, for both diagnosis and management, with emphasis on the new data suggesting US as a biomarker for tailoring a treatment approach for CTS patients.