Carpal tunnel syndrome in primary care: a report from ASPN. Ambulatory Sentinel Practice Network
Carpaltunnelsyndrome is the entrapment neuropathy of the medign nerve at the wrist. It is the most common nerve compression disorder seen by physicians, affecting women up to five times more frequently than men, especially during the reproductive years. Carpaltunnelsyndrome is known to be aggravated during pregnancy and menopause. Primary care physicians can expect to see approximately 1.01 cases of carpaltunnelsyndrome per 1,000 office encounters, with a female age-adjusted rate of 1.49 per 1,000 person-years. Physicians can identify this syndrome with an accurate and detailed history and physical exam. In most cases, electrodiagnostic studies, such as nerve conduction velocities and/or electromyography, should be performed to confirm the diagnosis. Although most cases of carpaltunnelsyndrome are idiopathic, it may occur secondary to a number of medical disorders, from other lesions involving the joint, or from repetitive hand movements. The ob/gyn physician should be familiar with these other etiologies prior to initiating treatment. Treatment should begin with nonoperative intervention, unless the nerve damage is severe. The ob/gyn physician can initiate measures such as wrist splinting and the changing of aggravating hand positions, which can alleviate symptoms for most mild cases. With failure of nonoperative management, surgical decompression is usually therapeutic. Release procedures can be performed by the traditional open method and by the newer and more controversial endoscopic techniques.