Patterns of carpal tunnel syndrome.

Patterns of carpal tunnel syndrome have been presented, each with characteristic history and physical examination findings. Overlap is common; however, a prominent pattern can usually be identified to recommend primary treatment. The cumulative trauma patterns of tenosynovitis and position can be controlled in about two thirds of cases by nonsurgical management. The other major cumulative trauma pattern, vibration, usually requires avoidance, which commonly involves a job change. The lumbrical pattern responds to surgery with special attention to complete distal release of the transverse carpal ligament. External pressure from tool use requires design modification. Anatomic variations due to arthritis, tumors, or trauma are contraindications for the endoscopic techniques.