Carpal tunnel syndrome cts remains a puzzling and disabling condition present in 3.8% of the general population. Cts is the most well known and frequent form of median nerve entrapment, and accounts for 90% of all entrapment neuropathies. This review aims to provide an overview of this common condition, with an emphasis on the pathophysiology involved in cts.

The clinical presentation and risk factors associated with cts are discussed in this paper. Also, the various methods of diagnosis are explored including nerve conduction studies, ultrasound, and magnetic resonance imaging. keywords: carpal tunnel syndrome, median nerve, entrapment neuropathy, pathophysiology, diagnosis. First described by paget in 1854 1 , carpal tunnel syndrome cts remains a puzzling and disabling condition commonly presented to rheumatologists and orthopaedic hand clinicians. It is a compressive neuropathy, which is defined as a mononeuropathy or radiculopathy caused by mechanical distortion produced by a compressive force 2 . The american academy of orthopaedic surgeons aaos clinical guidelines on the diagnosis of cts defines it as a symptomatic compression neuropathy of the median nerve at the level of the wrist 3 . Cts is the most well known and frequent form of median nerve entrapment 3 8 , and accounts for 90% of all entrapment neuropathies 9 .

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An entrapment neuropathy is a chronic focal compressive neuropathy caused by a pressure increase inside non flexible anatomical structures 10 . Cts is a neuropathy caused by entrapment of the median nerve at the level of the carpal tunnel, delimitated by the carpal bones and by the transverse carpal ligament 2 . Physiological evidence indicates increased pressure within the carpal tunnel, and therefore decreased function of the median nerve at that level 3 .

Other forms of median nerve entrapment neuropathies include pronator syndrome and anterior interosseous nerve syndrome. Pronator syndrome is defined as compression of the median nerve in the forearm that results in sensory alteration in the median nerve distribution of the hand and the palmar cutaneous distribution of the thenar eminence 11 , 12 . Anterior interosseous nerve syndrome 13 is characterised by complete or partial loss of motor function of the muscles innervated by the anterior interosseous nerve ain , a motor branch of the median nerve in the forearm 4 .

Cts is the most frequent entrapment neuropathy 2 , believed to be present in 3.8% of the general population 14 . 1 in every 5 subjects who complains of symptoms such as pain, numbness and a tingling sensation in the hands is expected to have cts based on clinical examination and electrophysiological testing 4 , idiopathic cts being the most common diagnosis in patients with these symptoms 15 . Incidence rates of up to 270,0 per year have been reported 16 , with a prevalence rate up to 9.2% in women and 6% in men 13 . More common in females than in males, its occurrence is commonly bilaterally with a peak age range of 40 to 60 years 17 although it occurs in all age groups.

The prevalence of cts in the united kingdome uk alone is 7 16% 9 much higher than the 5% prevalence in the united states us 3 . In all western countries, an increase is reported in the number of work related musculoskeletal disorders wmsds caused by strain and repeated movements biomechanical overload. In europe, in 1998, over 60% of upper limb musculoskeletal disorders recognised as work related were cts cases cases 18 ,19 . Some industries such as fish processing have reported the prevalence of cts in their workers to be as high as 73% 20 . This data may reflect the increasing level of sensitivity to this problem, which is translated into a higher number of reports, rather than reflecting an actual increase in the prevalence of cts 2 . There certainly has been an increase in the number of cts patients, but this could be due to the general increase in the life span of people and the increased number of diabetic patients 21 .