MOC-PS(SM) CME Article: Self-Assessment and Performance in Practice: The Carpal Tunnel

Learning Objectives: After studying the article, the participant should be able to: 1. Conduct an appropriate history and physical examination for a patient suspected of having carpal tunnel syndrome. 2. Understand the role of provocative and other diagnostic tests pertinent to the diagnosis of carpal tunnel syndrome. 3. Understand the goals of the surgical treatment of carpal tunnel syndrome and how to obtain these. 4. Appreciate the common complications of carpal tunnel surgery and their management. Summary: The purpose of this article is to review important aspects of the history, physical examination, diagnosis, and management of carpal tunnel syndrome. Associated diseases, predisposing factors, and prognostic features are explored. The significance of diagnostic studies and the variety of anesthetic techniques with which to perform the surgery are reviewed. Evidence regarding the different surgical approaches, such as the open versus the endoscopic, is examined. Postoperative care issues such as therapy and splinting are examined. Finally, complications of carpal tunnel surgery and their management are outlined. The Maintenance of Certification module series is designed to help the clinician structure his or her study in specific areas appropriate to his or her clinical practice. This article is prepared to accompany practice-based assessment of preoperative assessment, anesthesia, surgical treatment plan, perioperative management, and outcomes. In this format, the clinician is invited to compare his or her methods of patient assessment and treatment, outcomes, and complications with authoritative, information-based references. This information base is then used for self-assessment and benchmarking in parts II and IV of the Maintenance of Certification process of the American Board of Plastic Surgery. This article is not intended to be an exhaustive treatise on the subject. Rather, it is designed to serve as a reference point for further in-depth study by review of the reference articles presented.