Clinical symptoms of carpal tunnel syndrome (CTS) include numbness and paresthesias or pain in the median nerve distribution of the hand (excluding the palm) and fingers. Weakness, stiffness, or clumsiness of the hand also is seen. Atrophy of the thenar eminence may be seen with chronic CTS. Symptoms may be provoked by tapping or applying pressure over the carpal tunnel or with prolonged wrist flexion.

Clinical signs of CTS include dulled sensation or hyperesthesia in the median innervated fingertips.

Sensory nerve conduction slowing at the wrist should be confirmed with electrodiagnostic studies.

Patients with mild or intermittent symptoms may benefit from nonoperative therapies, including splinting, corticosteroid injections, and activity modification.

Pregnancy and untreated endocrinologic conditions such as acromegaly or hypothyroidism may cause reversible thickening of the transverse carpal ligament (TCL).

The procedure is contraindicated when there are other causes for neurologic symptoms, including cervical radiculopathy, C7 or middle trunk compression in the thoracic outlet, proximal median nerve compression by the Struthers ligament or the pronator teres muscle, and anterior interosseous nerve syndrome.

Patients with mild or intermittent symptoms may benefit from nonoperative therapies, including splinting, corticosteroid injections, and activity modification.

Pregnancy and untreated endocrinologic conditions such as acromegaly or hypothyroidism may cause reversible thickening of the transverse carpal ligament (TCL).

The procedure is contraindicated when there are other causes for neurologic symptoms, including cervical radiculopathy, C7 or middle trunk compression in the thoracic outlet, proximal median nerve compression by the Struthers ligament or the pronator teres muscle, and anterior interosseous nerve syndrome.

CTS usually can be accurately diagnosed based on clinical history and physical examination. Electrodiagnostic studies can serve to confirm the clinical diagnosis and evaluate the severity of nerve injury.

Local anesthetic and minimal conscious sedation provide sufficient anesthesia for most patients.

The patient is placed in the supine position. The arm is placed on an arm board with palm facing upward, and the arm is abducted 60 degrees.