Carpal tunnel syndrome. Etiology and endoscopic treatment.

Carpal tunnel syndrome involves classic symptoms of numbness and paresthesias in the radial three and one-half digits, most frequently nocturnal, with pain associated with this anatomic distribution. Thenar weakness and autonomic dysfunction occurs late in these patients and are usually seen in advanced cases. The wrist flexion test and local percussion sensitivity tests done on physical examination can be helpful in determining and confirming the diagnosis of carpal tunnel syndrome. The likelihood that operative treatment will be required for resolution of symptoms is heightened if the patient is involved in daily manual repetitive activities of the hand or wrist. Surgical decompression can be accomplished by either a limited open or new endoscopic carpal tunnel release techniques. Currently, the advantages and disadvantages present in both procedures and careful controlled studies conducted in a prospective and randomized fashion will be required to further delineate the indications for either procedure. Carpal tunnel release remains an operative procedure with the most predictable outcome with relief of symptoms for the patient.