Carpal Tunnel Syndrome

Last updated 20.09.12

 

Index

 

Definition

-  Pain, paresthesia & weakness in the hand due to compression of median nerve in carpal tunnel

 

 

Features

-  Most common Dx neuropathy

 

Causes

-  Trauma

-  Distal radius #

-  Carpal dislocation

-  Crush injury

-  Pregnancy

-  Chronic over use

-  Genetic predisposition: anatomy

-  Anything causing narrowing of carpal tunnel

-  OA, RA, Acromegaly, Obesity, Ganglion..

 

Associated S/S

-  Pain & paresthesia

-  Median nerve distribution: radial palm + 1st 3.5 fingers

-  Awakens pt from sleep

-  Shaking of hands to relieve discomfort

-  With progress daytime activities worsen: driving, phone, brushing hair..

-  Referred pain 30%

-  Forearm, elbow, shoulder, neck

 

 

-  Weakness

-  Weak thumb opposition & flexion

-  Lumbricals 1 & 2

-  Opponens pollicis

-  APB

-  FPB

-  +/- thenar atrophy

 

Ix

-  Hand Exam

-  Phalens Test: positive

-  Tinnels Sign: positive

-  Electromyography (EMG)

-  Nerve conduction studies: demyelination

 

Mx

-  NSAIDs

-  Splint

-  At night

-  During aggravating activities

-  Sx: Carpal tunnel release

-  90% return to same job post Sx

-  Recurrence rare