OVERVIEW
It has a “preference” for middle-aged menopausal women, while its onset can be dated both during pregnancy and breastfeeding. Pain in the wrist, tingling and numbness in the fingers are its two main characteristics, so it is easily confused with tendinitis and neck pain. Carpal tunnel syndrome is caused by the pressure applied on the median nerve, at the height of the wrist. This nerve is formed in the cervical spine, passes along the medial surface of the arm and the palmar surface of the forearm, and reaches the fingers through the carpal tunnel.

HIGH RISK GROUPS
A study published in Obesity Reviews in December 2016, links the increased risk of the syndrome’s appearance to excessive weight and obesity. However, endocrine and hormonal disorders, metabolic diseases (such as diabetes mellitus), systemic inflammatory diseases (most commonly, rheumatoid arthritis), fractures - dislocations in the radius and wrist, anatomical carpal tunnel anomalies due to genetic endowment, and local tumours, are considered responsible.
Also, the repetitive bending movements of the wrist, and, generally the excessive and intense use of the hands are considered “guilty” - the “candidates” are those who are engaged in heavy manual labour or in professions requiring constant computer use, or even throwing athletes, sports with a racket, artistic gymnastics, or athletes on a wheelchair.

WHICH ARE THE SYMPTOMS?
Symptoms usually appear gradually and worsen over time, and as long as the carpal tunnel syndrome remains undiagnosed and treated. Pain in the hand, burning, a sensation of “needle stings” and numbness in the thumb, index and middle fingers are the first signs. Symptoms subside or improve when the hand is at an elevated position or during exercise, but worsen when the wrist is bent, for example, while driving.
As the problem progresses, the pain can radiate to the shoulder, worsen during the night, even muscle weakness can be observed in the wrist, so the patient can not hold objects or turn a key in its lock.

WHICH IS THE BEST TREATMENT?
Early diagnosis is very important, so that the damage to the median nerve does not become permanent. The clinical examination of the entire upper extremity and the obtaining of a detailed history help the orthopaedist identify the source of the symptoms. The wrist is examined for pain, oedema and redness, which indicate an inflammation, a sensory function test is performed on the fingers and the muscles, and a power test is performed on the base of the thumb.
Blood tests are usually required for the controlling of glucose and rheumatoid factors, and the diagnosis is confirmed through an electromyography. Thus, it is found whether the damage is acute or chronic, and the function of the nerve is checked, at the same time.
If diagnosed at an early stage, carpal tunnel syndrome symptoms can be treated conservatively. In mild cases, splints, which are mainly worn during sleep, but can also be used during the day, restrain the bending movements of the wrist. Rest and change of activities help reduce the irritation of the area and the simultaneous administration of a medication relieve the pain and inflammation.
Some exercises are recommended for certain patients, to help the nerve move within the carpal tunnel more comfortably. For severe cases, cortisone injections to relieve the patient and the subsiding of the symptoms is an option, but only a temporary one.
However, since pain and numbness persist for a long time and to a point that affect the daily life of the suffering person, a surgical opening is performed. The aim is to decompress the median nerve, through a cross-section of the flexor retinaculum (transverse carpal ligament). The surgery can be performed either by applying the classic open incision, or endoscopically- the second technique gradually becomes more popular, as the use of the arthroscope helps prevent injuries, and thus reduces complication rates. In addition, the incisions (one or two) are much smaller, the continuity of the skin and underlying tissues is preserved and no scar is formed. Another advantage is the short recovery time.
However, in cases of patients with advanced median nerve compression, muscle atrophy and tenosynovitis, or in cases wrist fractures, the classical open surgical procedure is the selected option.
Postoperatively, dressings are applied for about two weeks, and the hand can be used for light work. Strength recovery takes place within 2 to 3 months after surgery, however, in cases where the median nerve was in a poor condition, the recovery period may even be as long as 6 months.