Sindrome del tunnel carpale: Attualità clinica, diagnostica e terapeutica

Carpal Tunnel Syndrome (CTS) is the most common compression neuropathy in the upper extremity, resulting from the entrapment of the median nerve within the carpal tunnel. Nine tendons and the median nerve are inclosed in this fairly rigid compartment bounded by the carpal bones and the flexor retinaculum. Increased pressure within the tunnel causes compression of the nerve. In most cases the syndrome is idiopathic, altough it is often associated with several risk factors and pathologies. Recurrent repetitive injury is now accepted as a major cause of the syndrome and CTS is considered today as occupational disease. Typical symptoms include numbness and paresthesia along the distribution of the median nerve. Tenar muscles weakness is a late manifestation of advanced disease. Tinel's and Phalen's signs are helpful in suggesting the diagnosis. Electrophysiological tests are helpful in confirming the diagnosis. There is no universally accepted therapy for CTS. Surgical treatment is widely preferred to not-surgical or conservative therapies (steroid treatment and physical therapy) for overtly symptomatic patients, while mild cases are usually not treated. This paper points on pathophysiological and clinical aspects of the syndrome. The proposed advantages and disvantages of the new diagnostic and therapeutic procedures are also discussed. We look at the current body of evidence to help determine optimal practice for the diagnosis and management of this condition.