The Mini Neurology Series, Volume 2: Carpal Tunnel Syndrome

Numbness. Tingling. “Pins and needles.” Nighttime hand symptoms that wake you up. Weakness and dropping things. These are the familiar signs of carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb. It occurs when the median nerve is compressed within a tight carpal tunnel at the wrist, producing numbness, tingling, burning, pain, a “dead” feeling in the fingers, and sometimes swelling or weakness of the hand. In advanced cases, permanent finger numbness and wasting of the muscles at the base of the thumb may occur.

In The Mini Neurology Series, Volume 2: Carpal Tunnel Syndrome, neurologist and electromyographer Britt Talley Daniel, MD explains why the syndrome develops, how it is diagnosed, and how it is treated.

An important theme of the book is that anatomy matters. Many people who develop CTS have a naturally small or otherwise compromised carpal tunnel, making the median nerve more vulnerable to compression. Repetitive hand use, wrist flexion and extension, vibration, pregnancy, diabetes, fluid retention, obesity, trauma, and other factors may then aggravate pressure within the tunnel.

The book reviews the characteristic symptoms and neurological examination, as well as conditions that can mimic CTS. It explains the role of the gold standard for diagnosing carpal tunnel syndrome, which is electrodiagnostic testing, including nerve conduction studies and the needle examination. Other tests that may help are imaging with X-ray, ultrasound, and MRI.

Treatment options discussed include:

• Rest and activity modification
• Neutral wrist splinting
• Cortisone injection
• Surgical carpal tunnel release

The book also examines the often-misunderstood relationship between computer use and carpal tunnel syndrome. Studies reviewed in the book found that frequent computer use alone did not clearly increase CTS risk above that of the general population, emphasizing that inherited anatomy and other medical and mechanical factors also matter.

Women are affected much more often than men, and the book notes a lifetime risk of CTS symptoms approaching 10%, while the estimated prevalence in the general population is lower.

Following the concise style of Volume 1 on migraine, Volume 2 gives readers a practical neurological guide to the numb, painful, weak, and sometimes swollen hand of carpal tunnel syndrome.

The Mini Neurology Series, Volume 2: Carpal Tunnel Syndrome
By Britt Talley Daniel, MD

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