The Carpal-Tunnel Syndrome

At the Cleveland Clinic the diagnosis of carpal-tunnel syndrome has been made in 654 hands of 439 patients during the last seventeen years. The typical patient with this syndrome is a middle-aged housewife with numbness and tingling in the thumb and index, long, and ring fingers, which is worse at night and worse after excessive activity of the hands. The sensory disturbances, both objective and subjective, must be directly related to the sensory distribution of the median nerve distal to the wrist; but pain may be referred proximal to the wrist as high as the shoulder. There is usually a positive Tinel sign over the median nerve at the wrist, and the wrist-flexion test I described is also usually positive. About half of the patients also have some degree of thenar atrophy. If steroid injections into the carpal tunnel give only transient relief, treatment should be by complete section of the transverse carpal ligament. This procedure will almost always relieve the patient's pain and numbness in the hand, and in many cases will also cure the paralysis of the thenar muscles, which may be present.