Carpal tunnel

Question 1

Superficial border of carpal tunnel

Answer 1

Flexor retinaculum

Question 2

What side does flexor retinaculum originate

Answer 2

Lateral side

Question 3

Contents of carpal tunnel

Answer 3

Flexor pollicis longus tendon - surrounded by synovial membrane
flexor digitorum profundus tendons and flexor digitorum superficialis tendons - surrounded by synovial membrane
Median nerve

Question 4

Deep border of carpal tunnel

Answer 4

Laterally - tubercles of scaphoid and trapezium

Medially - hooks of pisiform and hamate

Question 5

What is carpal tunnel syndrome

Answer 5

Compression of median nerve within carpal tunnel

Question 6

How can CTS be caused

Answer 6

Thickened ligaments and tendon sheaths in carpal tunnel

External compression e.g. Drop handle bars on bike

Question 7

Symptoms of CTS

Answer 7

Numbness, paresthesia and pain in median nerve sensory distribution which usually radiates to forearm
Pain worse in mornings and often wakes them up at night

Question 8

Tests for CTS

Answer 8

Tapping nerve in carpal tunnel to elicit pain in median nerve distribution (Tinel’s sign)
Holding wrist in Flexion for 1min to elicit numbness/pain in median nerve distribution (Phalen’s manoeuvre)

Question 9

Treatment of CTS

Answer 9

Splint to hold wrist in dorsiflexion over night
If unsuccessful:
Corticosteroid injections
Surgical decompression of carpal tunnel in severe cases

Question 10

Causes of carpal tunnel syndrome

Answer 10

MEDIAN TRAP
Myoedema
Oedema
Diabetes
Idiopathic
Acromegaly 
Neoplasm
Trauma
Rheumatoid arthritis
Amyloidoses
Pregnancy