Carpal tunnel syndrome is generally associated with such umbrella terms as repetitive stress injuries, work-related upper extremity disorders, musculoskeletal disorders, entrapment neuropathies, and cumulative trauma disorders [16,18]. Specifically, carpal tunnel syndrome is a painful disorder of the wrist and hand that occurs when the median nerve (which runs from the hand to the forearm) becomes compressed [1,19].

Several health conditions are associated with the presence of carpal tunnel syndrome and may be contributing factors in its development. The most commonly noted co-occurring health conditions are noninflammatory synovial fibrosis, metabolic syndrome, diabetes, thyroid disorders, rheumatoid arthritis, pregnancy, and menopause.

Cubital tunnel syndrome is caused by pressure on the ulnar nerve at the elbow. When the pressure increases enough to disturb normal nerve function, pain, numbness, and tingling may occur in the forearm or hand. Most often this pain is present in the ring and little fingers. Other symptoms that mirror carpal tunnel syndrome include decreased grip strength, weakness while pinching, and a feeling of clumsiness [1,9,85]. Individuals with cubital tunnel syndrome are more likely than individuals with carpal tunnel syndrome to present with muscle atrophy [23].

During Phalen's maneuver (wrist-flexion test), tingling or numbness may be produced by asking the patient to flex the wrists while extending the fingers. If symptoms occur within one minute, the presence of carpal tunnel syndrome is suggested [9,23]. A positive result with Phalen's maneuver may indicate severe carpal tunnel syndrome [92]. The test is not a reliable indicator of carpal tunnel syndrome in the diabetic population [93].

Many researchers and clinicians have concluded that for diagnosing carpal tunnel syndrome, EDX studies are most effective when used in conjunction with other diagnostic methods, when the diagnosis of carpal tunnel syndrome is uncertain, or when surgical treatment is being considered [109,127]. In its published guideline on the diagnosis of carpal tunnel syndrome, the American Academy of Orthopaedic Surgeons (AAOS) recommends against the use of EDX studies considering other standardized, low-cost options [106]. The AAOS finds little evidence to support EDX studies for other purposes, such as differentiating among diagnoses [101,106].

In addition to discussing desired outcomes, patient response to treatment should be assessed by one or more of the following instruments [64,65,66,71]:

Splinting has been found to improve patient satisfaction, symptoms, and function when measured at intervals of 2, 4, and 12 weeks. This may be particularly helpful when weighing the risks of surgery versus the benefits. Splinting is not recommended for use after routine carpal tunnel release surgery. The benefit of splinting for postoperative rehabilitation is undetermined [63,101,106]. The 2024 AAOS guidelines do not address splinting in the context of nonsurgical treatment.

Carpal tunnel release is the preferred treatment for patients with chronic or severe carpal tunnel syndrome. It is achieved by either an open or endoscopic procedure [9,99,101,106]. Both types of surgery are generally performed on an outpatient basis under local anesthesia. Open release surgery involves making an incision of up to 2 inches at the base of the palm of the hand and cutting the transverse carpal ligament, which releases pressure on the median nerve [9,45]. Endoscopic surgery involves making a small, one-half inch incision at the wrist and introducing an arthroscope beneath the transverse carpal ligament. Using the scope as a guide, the ligament is cut, relieving pressure on the median nerve [9,17,45].

Although the number of cases of carpal tunnel syndrome among U.S. workers has been declining, the resulting number of reported days away from work remains high [13]. This lost work time and decreased employee productivity have led employers to develop organizational approaches to managing employee health, safety, and productivity, with an emphasis on prevention and returning employees to work as quickly as possible [29,30]. Rising healthcare costs and the focus on preventing carpal tunnel syndrome have led researchers to study and recommend a variety of prevention strategies, including the application of ergonomic principles to job and workstation design, the use of ergonomically sound equipment (including ergonomic keyboards and dual numeric keyboards), the development of predictive models, and the use of exercise regimens and patient education and safety programs [17,22,24].