The median nerve at the carpal tunnel level is the most commonly entrapped peripheral nerve in the body, compressed between the carpal bones and the transverse carpal ligament. At this level the nerve carries motor fibres to the thenar muscles and sensory fibres to the radial three-and-a-half digits.
Carpal tunnel syndrome is diagnosed by sensory symptoms in the median nerve territory, positive Tinel's sign at the wrist, positive Phalen's test, and confirmed by nerve conduction studies showing prolonged distal motor and sensory latencies. Thenar wasting indicates advanced chronic compression. Surgical carpal tunnel release (open or endoscopic) decompresses the nerve at this level with excellent outcomes in appropriately selected patients.
Median nerve compression under the transverse carpal ligament producing nocturnal hand numbness and tingling in the radial digits, thenar wasting in severe cases, confirmed by NCS and treated by carpal tunnel release with high success rates.
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