Carpal Tunnel

Question 1

(1) An entrapment neuropathy caused by compression of the median nerve between the
carpal ligament and other structures within the carpal tunnel.
(2) Can be caused by repetitive wrist activities.
(3) Commonly seen during pregnancy and in patients with diabetes mellitus or rheumatoid arthritis.

Answer 1

Carpal Tunnel Syndrome overview

Question 2

(1) Pain, burning, and tingling in the distribution of the median nerve.
(a) Median nerve innervates thumb, pointer, middle and half of the ring finger
(2) Initially, most bothersome during sleep.
(3) Late in the syndrome weakness or atrophy of the thenar eminence may occur

Answer 2

Carpal tunnel syndrome presentation

Question 3

(1) Tinel or phalen’s sign exacerbates neuropathic symptoms
(2) Diagnosed with ultrasound and nerve conduction studies.

Answer 3

Carpal tunnel syndrome diagnosis

Question 4

(1) Patient should modify their hand activities and the affected wrist should be splinted in neutral position for up to 3 months.
(2) Oral or injected steroids or NSAIDS can help decrease inflammation and lesson pain.
(3) ***Refer if symptoms persist more than 3 months despite conservative treatment, including the use of a wrist splint OR if thenar muscle (e.g., abductor pollicis brevis) weakness or atrophy develops.
(4) Treatment is directed toward relief of pressure on the median nerve.

Answer 4

Carpal tunnel syndrome treatment