The compressive element of the pathophysiology includes a detrimental cycle of increased pressure, obstruction of overall venous outflow, increasing local edema, and compromise to the median nerve's intraneural microcirculation. In general, the pathophysiology of CTS results from a combination of compression and traction mechanisms. While this can be appreciated in select medical conditions (e.g., gout), these relatively straightforward clinical presentations are relatively uncommon in comparison to most presentations of CTS. A single, specific cause is not always determined unless there is, for example, a space-occupying lesion that can be attributable to patient-reported symptoms. Ĭarpal tunnel syndrome (CTS) is multifactorial and often results from multiple patient-specific, occupational, social, and environmental risk factors. Typical occupations of patients with carpal tunnel syndrome include those who use computers for extended periods of time, those who use equipment that has vibration such as construction workers, and any other occupation requiring frequent, repetitive movement. In more advanced disease, symptoms can be constant. With further progression of the disease, symptoms will also be present during the day, especially with certain repetitive activities, such as when drawing, typing, or playing video games. In the early presentation of the disease, symptoms most often present at night when lying down and are relieved during the day. With further progression, hand weakness, decreased fine motor coordination, clumsiness, and thenar atrophy can occur. Pain also can radiate up the affected arm. These symptoms typically present, with some variability, in the thumb, index finger, middle finger, and the radial half (thumb side) of the ring finger. Early symptoms of carpal tunnel syndrome include pain, numbness, and paresthesias. It is the most common nerve entrapment neuropathy, accounting for 90% of all neuropathies. Carpal tunnel syndrome (CTS) is an entrapment neuropathy caused by compression of the median nerve as it travels through the wrist's carpal tunnel.
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