Carpal tunnel syndrome (CTS) is a medical condition in which the median nerve is compressed at
the wrist, leading to pain, paresthesias, and muscle weakness in the
forearm and hand.
A form of peripheral
neuropathy, CTS is more common in women than it is in men, and, though it
can occur at any age, has a peak incidence around age 42.
The lifetime risk for CTS is around 10% of the adult population.
CTS became widely known to the general public in the 1990's as a result of
the significant increase in chronic wrist pain due to the rapid expansion of
Other conditions may also be
misdiagnosed as carpal tunnel syndrome.
The median nerve passes
through the carpal
tunnel, a canal in the wrist that is surrounded by bone on three sides, and
a fibrous sheath (the flexor retinaculum
) on the fourth. In
addition to the nerve, nine tendons —
the flexor tendons of the hand—pass through this canal.
median nerve can be compressed by a decrease in the size of the canal or an
increase in the size of the contents (such as the swelling of the lubrication
tissue around the flexor tendons), or both. Simply bending the wrist at 90
degrees will decrease the size of the canal.
The first symptoms of CTS may appear when sleeping, and typically include
numbness and paresthesia (a
burning and tingling sensation in the fingers, especially the thumb, index, and
These symptoms appear at night because
many people sleep with bent wrists which further compresses the carpal tunnel.
If the median nerve is already under stress, the increased compression of the
bent wrist creates the numbness and tingling. Difficulty gripping and making a
fist, dropping objects, and weakness are symptoms of progression. In early
stages of CTS individuals often mistakenly blame the tingling and numbness on
restricted blood circulation and they believe their hands are simply "falling
It is important to note that unless numbness or paresthesia are among the
predominant symptoms, it is unlikely the symptoms are primarily caused by carpal
tunnel syndrome. In effect, pain of any type, location, or severity with the
absence of significant numbness or paresthesia
is not likely to fall
under this diagnosis.
Most cases of CTS areidiopathic
Many people with carpal tunnel
syndrome have gradually increasing symptoms over time. A common factor in
developing carpal tunnel symptoms is increased hand use or activity. While
repetitive activities are often blamed for the development of CTS, the
correlation is often unclear. Physiology and family history may have a
significant role in individual's susceptibility.
The relationship between work and CTS is controversial; in many locations
workers injured at work are entitled to time off and compensation.
Many cases of carpal tunnel syndrome
are provoked by repetitive grasping and manipulating activities, and the
exposure can be cumulative. Symptoms are commonly exacerbated by forceful and
repetitive use of the hand and wrists in industrial occupations.
Carpal tunnel syndrome results in
billions of dollars of workers compensation claims every year.
Studies done by the National
Institute for Occupational Safety and Health (NIOSH), indicated that job
tasks involving highly repetitive manual acts or necessitating wrist bending or
other stressful wrist postures were connected with incidents of CTS or related
problems. However, it appears that the 30+ studies reviewed were concerned with
the occupations of assembly line workers, meat packers, food processors, and the
like, not general office work.
In addition, a 2005 study found that people who have discomfort at the base
of the neck or in the shoulder or work with their shoulder in elevation
(indicators of poor working postures) are more likely to develop a repetitive
These factors can affect the biomechanics of the upper limb
or tissue tolerance to repetitive tasks resulting in injury, or both. Postural
and spinal assessment along with ergonomic assessments should be included in the
overall determination of the condition. Addressing these factors have been found
to improve the status of work related upper limb injuries.
Hyperthyroidism, osteoarthritis and diabetes were most often associated
with CTS-like symptoms, as were variables such as age, obesity and wrist
dimension. In a 1998 study, only 35 of 297 subjects were aware of the underlying
health condition which could account for their CTS-like symptoms.
Hence, these causes would be missed by doctors if they were relying on a
patient's health history to rule out other causative factors. It is important
that a doctor rule out other causes of CTS-like symptoms. If a patient does not
have CTS, corrective surgery is destined to fail.
Studies have also related carpal tunnel and other upper extremity complaints
with psychological and social factors. A large amount of psychological distress
showed doubled risk of the report of pain, while job demands, poor support from
colleagues, and work dissatisfaction also showed an increase in the report of
pain, even after short term exposure.
A minority viewpoint holds that stress is the main cause, rather than a
contributing factor, of a large fraction of pain symptoms usually attributed to
carpal tunnel syndrome. The main advocate of this point of view, Dr. John Sarno, considers that carpal
tunnel syndrome, back pain and other pain syndromes, although they sometimes
have a physical cause, are more often a manifestation of Tension
Myositis Syndrome, a psychosomatic disorder resulting from continued
has reported a high success rate in curing patients through relaxation and a
greater awareness of the role of emotions in triggering symptoms.
- Fractures of
one of the arm bones, particularly a Colles' fracture.
- Dislocation of one of the
carpal bones of the wrist.
- Strong blunt trauma to the wrist or lower forearm, incurred for example by
using arm extremity to cushion a fall or protecting oneself from falling heavy
- Hematoma forming inside the
wrist, because of internal hemorrhaging.
- Deformities due to abnormal healing of old bone fractures.
Misalignment between carpal bones should be the most common cause of CTS,
because by adjusting these bones' alignment, CTS dramatically decreases.
Non-traumatic causes generally happen over a period of time, and are not
triggered by one certain event. Many of these factors are manifestations of
physiologic aging and should not be considered preventable. Examples
- Tenosynovitis, which
is inflammation of the thin
mucinous membrane around the tendons. Part of the process of inflammation is
swelling, and this compresses the nerve. Swelling of this membrane is the final
common pathway for most cases of carpal tunnel, whether caused idiopathically,
through exposure, or medically.
- With pregnancy and hypothyroidism, fluid is
retained in tissues, which swells the tenosynovium.
- Acromegaly, a disorder of growth hormones,
compresses the nerve by the abnormal growth of bones around the hand and wrist.
- Tumours (usually benign), such as a
ganglion or a lipoma, can protrude into the carpal tunnel, reducing
the amount of space. This is exceedingly rare (less than 1%).
- Double crush syndrome, where there is compression or irritation of
nerve branches contributing to the median nerve in the neck or anywhere above
the wrist. This then increases the sensitivity of the nerve to compression in
the wrist. This, while a possible factor, is also a rare contributor in most
- Idiopathic causes, which no
one can explain, can also cause this disease. This is very common.
- Common activities that have been identified as contributing to repetitive
stress induced carpal tunnel syndrome include:
- Use of power tools
- Construction work such as handling many bricks, stone and/or lumber
- Computer keyboarding or typing
- Playing video games or computer games (particularly MMORPGs, where the game often rewards marathon play
sessions(Goddamn WoW nerds))
- Playing a musical instrument
- Cycling, due to pressure and
vibration on hands
- Crafting, such as knitting or
- Any activity where hand use is vigorous and routine could contribute
(surgeons, dentists). Still, these activities are often merely associated with,
but do not actually cause, carpal tunnel syndrome.
Often people suffering from carpal tunnel syndrome can have multiple
contributing factors which are aggravated by vigorous hand activities and
repetitive stress trauma to the hand.
Proper attention to ergonomic
considerations can reduce or eliminate these kinds of exposures.
While carpal tunnel syndrome is often called a "repetitive strain injury" (RSI) or "cumulative trauma disorder" (CTD),
these labels are discouraged by physicians, particularly hand specialists.
is a specific condition with specific symptoms that
responds fairly reliably. Most of the time, carpal tunnel is not caused by a
"strain" or "trauma" of any type. RSI and CTD are relatively non-specific terms
with non-specific symptoms that respond variably to treatment.
Clinical assessment by history taking and physical examination can frequently
maneuver is performed by flexing the wrist gently as far as possible, then
holding this position and awaiting symptoms. A positive
test is one that results in numbness in the median nerve distribution. The
quicker the numbness starts, the more advanced the condition.
- Tinel's sign, a
classic, though less specific test, is a way to detect irritated nerves. Tinel's
is performed by lightly tapping (percussing) the area over the nerve to
elicit a sensation of tingling or "pins and needles" in the nerve distribution.
- The carpal compression test, or applying firm pressure of the palm
over the nerve to elicit symptoms has also been proposed.
If, based on history and physical examination, a CTS diagnosis is suspected
but not clear, patients will likely be tested electrodiagnostically with nerve
conduction studies and electromyography; MRI or ultrasound
imaging are also used.
The most effective way to prevent carpal tunnel syndrome is to take frequent
breaks from repetitive movement such as computer keyboard usage. Free software
programs such as Workrave are
available to remind users to take breaks and stretch their wrists.
There has been much discussion as to the most effective treatment for
However, treatments can be generally
divided into six basic categories:
Some causes of CTS are secondary to other conditions — metabolic disorders
such as hyperthyroidism, for example. Treatment of the
primary disorder often resolves CTS symptoms.
The importance of wrist braces and splints in the carpal tunnel syndrome
therapy is known for many people, but many people are unwilling to use it. In
1993, The American Academy of Neurology recommend a non-invasive treatment for
the CTS at the beginning (except for sensitive or motor deficit or grave report
at EMG/ENG): a therapy using splints was indicated for light and moderate
recommendations generally don't suggest immobilizing braces, but instead
activity modification and non-steroidal
anti-inflammatory drugs as initial therapy, followed by more aggressive
options or specialst referral if symptoms do not improve. 
Many health professionals suggest that, for best results, one should wear
braces at night and, if possible, during the activity primarily causing stress
on the wrists.
Healing braces can sometimes
exacerbate the cause of wrist pain and misalignment by continuing to prohibit
proper functionality of the wrist.
Physiotherapy offers several ways to treat and control carpal tunnel
syndrome. This procedure should be directed specifically towards the pattern of
pain / symptoms and dysfunction assessed by the therapist. As such, it may
include a range of modalities ranging from soft tissue massage, conservative
stretches and exercises, splints, and techniques to directly mobilise the nerve
Clinically, sometimes a patient will present with a hand that is very
inflamed and swollen with severe symptoms of pain, tingling and numbness and
almost a fear of use due to the pain. In these cases a physiotherapist may focus
on techniques to reduce the pain and inflammation, and exercises to encourage
improved circulation. A comprehensive review of effectiveness of hand therapies
in carpal tunnel management demonstrates that there is some valid scientific
evidence for a range of therapeutic modalities.
Body Awareness Therapy such as the Feldenkrais method has been studied in
relation to fibromyalgia and
chronic pain and studies have indicated positive effects.
Structured exercise programs using these therapies to reduce wrist pain have
CTS is a multi-faceted problem and can be challenging to treat from a
clinicians perspective. Starting therapy early when carpal tunnel is in a mild
stage is associated with improved long-term results.
Localized steroid injections
Steroid injections can be quite effective for temporary relief from symptoms
of CTS for a short time frame while a patient develops a longterm strategy that
fits with his/her lifestyle. In certain patients an injection may also be of
diagnostic value. This treatment is not appropriate for extended periods,
however. In general, medical professionals only prescribe to localized steroid
injections until other treatment options can be identified. For most patients,
permanent relief requires surgery.
Prioritizing hand activities and ergonomics
Any forceful and repetitive use of the hands and wrists can cause upper
extremity pain. More frequent rest can be useful if it can be orchestrated into
one's schedule. It has been shown that taking multiple mini breaks during the
stressful activity is more effective than taking occasional long breaks. There are
computer applications that aid users in taking breaks. All of these applications
have recommended defaults, following the most effective average break
configuration, which is a 30 sec. pause every 3 to 5 minutes (the more severe
the pain, the more often one should take this break). Before investing in these
types of programs, it's best to consult with a doctor and research whether
computer use is causing or contributing to the symptoms, as well as getting a
More pro-active ways to reducing the stress on the wrists which will
alleviate wrist pain and strain involve adopting a more ergonomic work and life
environment. Switching from a QWERTY
computer keyboard layout to the Dvorak Simplified Keyboard layout
was commonly cited as beneficial in early CTS studies, however meta-analyses of these
studies report significant flaws in the research and question the usefulness of
It is also important that one's body be aligned properly with the keyboard.
This is most easily accomplished by bending ones elbows to a 90 degree angle and
making sure the keyboard is at the same height as the elbows. Also it is
important not to put physical stress on the wrists by hanging the wrist on the
edge of a desk, or exposing the wrists to strong vibrations (e.g. manual lawn
mowing). Position the computer monitor directly in front of your seat, so the
neck is not twisted to either side when viewing the screen.
Exercises that relax and strengthen the muscles of the upper back can reduce
the risk of a double crush
of the median nerve. Spinal manipulations
performed by an osteopath,
physical therapist or chiropractor may be appropriate to relieve compression of
Using an over-the-counter anti-inflammatory such as aspirin, ibuprofen or Naproxen can be effective as well for
controlling symptoms. Pain relievers like Tylenol will only mask the pain, and only an
anti-inflammatory will affect inflammation. Non-steroidal inflammatory
medications theoretically can treat the root swelling and thus the source of the
problem. Oral steroids (prednisone) do the same, but are generally not used
for this purpose due to significant side effects. The most common complications
associated with long-term use of anti-inflammatory medications are
gastrointestinal irritation and bleeding. Also, some anti-inflammatory
medication have been linked to heart complications. Use of anti-inflammatory
medication for chronic, long-term pain should be done with doctor
A more aggressive pharmaceutical option is an injection of cortisone, to reduce swelling and nerve pressure
within the carpal tunnel.
Mecobalamin/Methylcobalamin has been
helpful in some cases of CTS. 
Carpal tunnel release surgery
When visiting a hand surgeon, the first step would be examination of the
hands and a review of the symptoms. If CTS is suspected, depending on the
severity and the situation, the surgeon may first prescribe non-operative
treatment with splinting and anti-inflammatory drugs. Nerve conduction test will
positively determine the level of compression, if any.
If symptoms resolve with non-surgical interventions, surgery can frequently
be avoided. If not, then the "carpal tunnel release" surgery is recommended.
In general, milder cases can be controlled
for months to years, but severe cases are unrelenting symptomatically and likely
will come to surgical treatment.
There are several carpal tunnel release surgery variations: each surgeon has
differences of preference based on their personal beliefs and experience. All
techniques have several things in common, involving brief outpatient procedures; palm or wrist incision(s);
and cutting of the transverse carpal ligament.
All of the surgical options typically have relatively rapid recovery profiles
(days to weeks depending on the activity and technique), and all usually leave a
cosmetically insignificant scar.
The two major types of surgery are open-hand surgery
. Most surgeons perform open surgery, widely considered to be the
gold standard. However,
many surgeons are now performing endoscopic techniques. Open surgery involves a
small incision somewhere on the palm about an inch or two in length. Through
this the ligament can be directly
viewed and divided with relative safety. Endoscopic techniques involve one or
two smaller incisions (less than half inch each) through which instrumentation
is introduced including probes, knives and the scope to see what you are doing.
The ligament is viewed through a "keyhole" in this way and can be divided with
Surgery to correct carpal tunnel syndrome has a 90% or higher success rate,
especially using endoscopic surgery techniques.
In general, endoscopic techniques are as
effective as traditional open carpal surgeries,
though the faster recovery time typically noted in endoscopic procedures may be
offset by higher complication rates.
Success is greatest in patients
with the most typical symptoms. The most common cause of failure is incorrect
diagnosis, and it should be noted that this surgery will only fix carpal tunnel
syndrome, and will not relieve symptoms with alternate causes. Recurrence is
rare, and apparent recurrence usually results from a misdiagnosis of another
problem. Complications can occur, but serious ones are infrequent to rare.
Carpal tunnel surgery is usually performed by an orthopaedic or plastic surgeon; some
neurosurgeons and general
surgeons also perform the procedure.
Long term recovery
Most people who find relief of their carpal tunnel symptoms with conservative
or surgical management find minimal residual or "nerve damage".
Long-term chronic carpal tunnel syndrome
(typically seen in the elderly) can result in permanent "nerve damage", i.e.
symptoms of numbness, muscle wasting and weakness.
While outcomes are generally good, certain factors can contribute to poorer
results that have little to do with nerves, anatomy, or surgery type. One study
showed that mental status parameters, alcohol use, yield much poorer overall
results of treatment.
Many mild carpal tunnel syndrome sufferers either change their hand use
pattern or posture at work or find a conservative, non-surgical treatment that
allows them to return to full activity without hand numbness or pain, and
without sleep disruption. Other people end up prioritizing their activities and
possibly avoiding certain hand activities so that they can minimize pain and
perform the essential tasks.
Changing jobs is also commonly done to avoid continued repetitive stress
tasks. Others find success by adjusting their repetitive movements, the
frequency with which they do the movements, and the amount of time they rest
between periods of performing the movements.
In summary, one has the choice of controlling
the symptoms with any of
the non-surgical options listed, or correcting
the condition with
While recurrence after surgery is a possibility, true recurrences are
uncommon to rare.
Non-CTS hand pain is commonly mistaken
for recurrence. Such hand pain may have existed prior to the surgery, which is
one reason it is very important to get a proper diagnosis.
- ^ Michelsen H, Posner M (2002). "Medical history of
carpal tunnel syndrome". Hand Clin 18 (2): 257-68. PMID
Treaster DE, Burr D (2004). "Gender differences
in prevalence of upper extremity musculoskeletal disorders".
Ergonomicdsvss 47 (5): 495-526. PMID
- ^ a b c eMedicine EMERG/83
- ^ a b Sternbach G (1999). "The carpal tunnel syndrome".
J Emerg Med 17 (3): 519-23. PMID
Derebery J (2006). "Work-related carpal tunnel
syndrome: the facts and the myths". Clin Occup Environ Med 5 (2):
353-67, viii. PMID
Werner R (2006). "Evaluation of work-related
carpal tunnel syndrome". J Occup Rehabil 16 (2): 207-22. PMID
Werner R, Franzblau A, Gell N, Ulin S,
Armstrong T (2005). "A longitudinal study of industrial and clerical workers:
predictors of upper extremity tendonitis". J Occup Rehabil 15 (1):
- ^ Cole D, Hogg-Johnson S, Manno M, Ibrahim S, Wells R,
Ferrier S (2006). "Reducing musculoskeletal burden through ergonomic program
implementation in a large newspaper". Int Arch Occup Environ Health
80 (2): 98-108. PMID
Atcheson SG, Ward JR, Lowe W (1998).
"Concurrent medical disease in work-related carpal tunnel syndrome". Arch
Intern Med 158 (14): 1506-12. PMID
Atcheson SG (1999). "Carpal tunnel syndrome: is
it work-related?". Hosp Pract (Minneap) 34 (3): 49-56; quiz 147.
- ^ Nahit ES, Pritchard CM, Cherry NM, Silman AJ,
Macfarlane GJ (2001). "The influence of work related psychosocial factors and
psychological distress on regional musculoskeletal pain: a study of newly
employed workers". J Rheumatol 28 (6): 1378-84. PMID
- ^ Sarno, John E
(2006). The Divided Mind: The Epidemic of Mindbody Disorders. Regan
- ^ Sarno, John E
(1991). Healing Back Pain: The Mind-Body Connection. Warner Books. ISBN
- ^ Cush JJ, Lipsky PE (2004). Approach to
articular and musculoskeletal disorders, In: Harrison's Principles of Internal
Medicine, 16th, McGraw-Hill Professional, p. 2035. ISBN
Gonzalez del Pino J, Delgado-Martinez AD,
Gonzalez Gonzalez I, Lovic A (1997). "Value of the carpal compression test in
the diagnosis of carpal tunnel syndrome". J Hand Surg [Br] 22 (1):
- ^ Wilder-Smith E, Seet R, Lim E (2006). "Diagnosing
carpal tunnel syndrome--clinical criteria and ancillary tests". Nat Clin
Pract Neurol 2 (7): 366-74. PMID
- ^ Bland J (2005). "Carpal tunnel syndrome". Curr
Opin Neurol 18 (5): 581-5. PMID
Jarvik J, Yuen E, Kliot M (2004). "Diagnosis of
carpal tunnel syndrome: electrodiagnostic and MR imaging evaluation".
Neuroimaging Clin N Am 14 (1): 93-102, viii. PMID
Wilson JK, Sevier TL (2003). "A review of
treatment for carpal tunnel syndrome". Disabil Rehabil 25 (3):
- ^ American Academy of Neurology (2006). "Quality
Standards Subcommittee: Practice parameter for carpal tunnel syndrome.". Eura
Medicophys Neurology (43): 2406-2409. PMID
- ^ American Academy of Orthopaedic Surgeons (1996). "Clinical Guideline on wrist pain.
National Guideline clearinghouse".
- ^ Katz JN, Simmons BP (2002). "Carpal tunnel
syndrome.". NEJM 346: 1807-1812. PMID
Harris JS (1998). "ed. Occupational Medicine
Practice Guidelines: evaluation and management of common health problems and
functional recovery in workers.". Beverly Farms, Mass.: OEM Press. ISBN
- ^ Premoselli S, Sioli P, Grossi A, Cerri C (2006).
"Neutral wrist splinting in carpal tunnel syndrome: a 3- and 6-months clinical
and neurophysiologic follow-up evaluation of night-only splint therapy". Eura
- ^ Michlovitz SL (2004). "Conservative interventions for
carpal tunnel syndrome". J Orthop Sports Phys Ther 34 (10):
Muller M, Tsui D, Schnurr R, Biddulph-Deisroth
L, Hard J, MacDermid J (2004). "Effectiveness of hand therapy interventions in
primary management of carpal tunnel syndrome: a systematic review". J Hand
Ther 17 (2): 210-28. PMID
- ^ Gard G (2005). "Body awareness therapy for patients
with fibromyalgia and chronic pain". Disabil Rehabil 27 (12):
- ^ Hui AC, Wong S, Leung CH, Tong P, Mok V, Poon D,
Li-Tsang CW, Wong LK, Boet R (2005). "A randomized controlled trial of surgery
vs steroid injection for carpal tunnel syndrome". Neurology 64
(12): 2074-8. PMID
Lincoln A, Vernick J, Ogaitis S, Smith G,
Mitchell C, Agnew J (2000). "Interventions for the primary prevention of
work-related carpal tunnel syndrome.". Am J Prev Med 18 (4 Suppl):
Verhagen A, Karels C, Bierma-Zeinstra S,
Burdorf L, Feleus A, Dahaghin S, de Vet H, Koes B (2006). "Ergonomic and
physiotherapeutic interventions for treating work-related complaints of the arm,
neck or shoulder in adults.". Cochrane Database Syst Rev 3:
- ^ Sato Y, Honda Y, Iwamoto J, Kanoko T, Satoh K (2005).
"Amelioration by mecobalamin of subclinical carpal tunnel syndrome involving
unaffected limbs in stroke patients.". J Neurol Sci 231 (1-2):
- ^ Hui AC, Wong SM, Tang A, Mok V, Hung LK, Wong KS
(2004). "Long-term outcome of carpal tunnel syndrome after conservative
treatment". Int J Clin Pract 58 (4): 337-9. PMID
- ^ Kouyoumdjian JA, Morita MP, Molina AF, Zanetta DM,
Sato AK, Rocha CE, Fasanella CC (2003). "Long-term outcomes of symptomatic
electrodiagnosed carpal tunnel syndrome". Arq Neuropsiquiatr 61
(2A): 194-8. PMID
- ^ Schmelzer RE, Della Rocca GJ, Caplin DA (2006).
"Endoscopic carpal tunnel release: a review of 753 cases in 486 patients".
Plast Reconstr Surg 117 (1): 177-85. PMID
- ^ Quaglietta P, Corriero G (2005). "Endoscopic carpal
tunnel release surgery: retrospective study of 390 consecutive cases". Acta
Neurochir Suppl 92: 41-5. PMID
- ^ Park SH, Cho BH, Ryu KS, Cho BM, Oh SM, Park DS
(2004). "Surgical outcome of endoscopic carpal tunnel release in 100 patients
with carpal tunnel syndrome". Minim Invasive Neurosurg 47 (5):
- ^ Scholten RJ, Gerritsen AA, Uitdehaag BM, van Geldere
D, de Vet HC, Bouter LM (2004). "Surgical treatment options for carpal tunnel
syndrome". Cochrane Database Syst Rev (4): CD003905. PMID
McNally SA, Hales PF (2003). "Results of 1245
endoscopic carpal tunnel decompressions". Hand Surg 8 (1): 111-6.
- ^ Thoma A, Veltri K, Haines T, Duku E (2004). "A
meta-analysis of randomized controlled trials comparing endoscopic and open
carpal tunnel decompression". Plast Reconstr Surg 114 (5):
- ^ Chow JC, Hantes ME (2002). "Endoscopic carpal tunnel
release: thirteen years' experience with the Chow technique". J Hand Surg
[Am] 27 (6): 1011-8. PMID
- ^ Olsen KM, Knudson DV (2001). "Change in strength and
dexterity after open carpal tunnel release". Int J Sports Med 22
(4): 301-3. PMID
- ^ Katz JN, Losina E, Amick BC 3rd, Fossel AH, Bessette
L, Keller RB (2001). "Predictors of outcomes of carpal tunnel release".
Arthritis Rheum 44 (5): 1184-93. PMID
- ^ Gerritsen AA, de Vet HC, Scholten RJ, Bertelsmann FW,
de Krom MC, Bouter LM (2002). "Splinting vs surgery in the treatment of carpal
tunnel syndrome: a randomized controlled trial". JAMA 288 (10):
- ^ Ruch DS, Seal CN, Bliss MS, Smith BP (2002). "Carpal
tunnel release: efficacy and recurrence rate after a limited incision release".
J South Orthop Assoc 11 (3): 144-7. PMID
Reproduced under the Wikipedia