Carpal Tunnel ☺️

Question 1

Epidemiology

Etiology and pathophysiology

Answer 1

Most common compression neuropathy of the upper limb
More female

Cause unknown but associated with

• repetitive wrist movements
• obesity, pregnancy
• RA

Question 2

Presentation

Answer 2

Numb, tingling, pain in thumb, 1st, 2nd, half of 3rd
-radiates up wrist, arm, shoulder
Weak thumb, difficulty gripping

Symptoms come and go
Worse at night

Sensory loss in median nerve distribution
Atrophy of thenar, reduced strength
Phalens - wrist flexion => pain, tingling
Tinels - tapping over median nerve => pain, tingling
Durkan - pressure over tunnel => pain, tingling

Question 3

Possible differentials

Answer 3

Trauma
-fracture leading to nerve damage

AI
-RA

Metabolic

• DM, obesity
• B12 deficiency

Degenerative

• OA => wrist stiffness
• cervical radiculopathy => depending on root affected
• MND => often starts with CT like symptoms but progresses
• MS => hand position doesn’t make a difference

Endocrine
-hypothyroidism

Question 4

Management

• lifestyle
• pharmacological
• surgical

Answer 4

Lifestyle

• manage underlying conditions (hypothyroid, obesity, RA, OA)
• avoidance of repetitive movements (workplace adaptations, more breaks)
• wrist splinting

Pharmacological if lifestyle changes aren’t enough
-CS injection

Surgery
-surgical release if CS not enough

Question 5

Prognosis

Answer 5

Often self limiting but can fluctuate during periods of increased hand use