Neurology
Carpal Tunnel Syndrome
손목터널증후군
Median nerve compression at the carpal tunnel
- How common
- 3–6%, women 3x
- Typical age
- Ages 40–60
What is it?
Increased carpal tunnel pressure compresses median nerve, causing ischemia and demyelination.
Commonly affected: Thumb, index, middle, lateral half of ring (median)
How it develops
- Tunnel pressure riseWrist flexion, repetitive use, edema
- Median nerve compressionCompressed beneath transverse carpal ligament
- Microvascular ischemiaEndoneurial vessel damage
- DemyelinationProgressive axonal loss can be permanent
Symptoms
- Nocturnal paresthesiaWakes at night; relieved by shaking
- Thenar atrophy (late)Thenar eminence wasting
- Thumb weaknessDifficulty opening jars, buttoning
- Median sensory lossThumb, index, middle, lateral ring
How it is examined
- Tinel's signTapping wrist → finger paresthesia
- Phalen's testWrist flexion 60s reproduces symptoms
- Durkan's compressionDirect wrist compression 30s
Imaging
Plain X-ray not used for diagnosis.
- N/A
NCS/EMG is standard; ultrasound can measure median nerve CSA.
- Reduced median NCV
- Prolonged distal latency
Non-surgical care
- Night splintNeutral wrist splint at night
- NSAIDsShort-term pain control
- Steroid injectionMethylprednisolone into tunnel (short-term)
- Activity modificationAvoid wrist flexion; ergonomic changes
- Nerve glidingMedian nerve gliding exercises
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Failed conservative care, thenar atrophy, severe EMG
Procedures that may be discussed
- Open carpal tunnel release
- Endoscopic carpal tunnel release
Outlook
Mild cases improve conservatively; surgery >90% success.