Management of Carpal Tunnel Syndrome - American Family Physician

www.aafp.org/afp AMERICAN FAMILY PHYSICIAN 265 nerve (Figure 1), although numbness in all fingers may be a more common presentation. Symptoms are usually worse at night and can awaken patients from sleep. To relieve the symptoms, patients often “flick” their wrist as if shaking down a thermometer (flick sign). In patients with carpal tunnel syndrome, pain and paresthesias may radiate to the forearm, elbow, and shoulder. Decreased grip strength may result in loss of dexterity, and thenar muscle atrophy may develop if the syndrome is severe. C arpal tunnel syndrome, the most common focal peripheral neuropathy, results from compression of the median nerve at the wrist. The syndrome affects an estimated 3 percent of adult Americans and is approximately three times more common in women than in men. High prevalence rates have been reported in persons who perform certain repetitive wrist motions, but the significance of this relationship continues to be challenged. Although 30 percent of frequent computer users complain of hand paresthesias, only 10 percent meet clinical criteria for carpal tunnel syndrome, and nerve conduction studies are abnormal in only 3.5 percent of these persons. Family physicians frequently encounter patients who may have carpal tunnel syndrome. This article reviews the clinical features, diagnosis, and treatment of this relatively common condition.