Carpal Tunnel

Question 1

What is carpal tunnel syndrome?

Answer 1

compression neuropathy involving the median nerve

MC compression neuropathy in UE

F>M

Question 2

Risk factors for carpal tunnel syndrome?

Answer 2

obesity, pregnancy, DM, RA, hypothyroidism, workplace factors

Question 3

What forms the carpal tunnel? What are its contents?

Answer 3

flexor retinaculum, carpal bones

9 flexor tendons, median nerve

Question 4

Pathophys of carpal tunnel syndrome?

Answer 4

median nerve compression > inflammation > ischemia > nerve damage

compression is often multifactorial

Question 5

Presentation of carpal tunnel syndrome?

Answer 5

• vague aching that radiates into the thenar area
• pain + numbness in median distribution
• pain worsened by repetitive motions/activities or remaining stationary for prolonged periods
• sxs worse at night
• patient feels need to “shake out” hand > FLICK SIGN

Question 6

carpal tunnel syndrome PE?

Answer 6

• look for thenar atrophy
• test thumb opposition against resistance
• eval sensation over median nerve distribution
• Phalen’s test
• Tinel’s sign

Question 7

How do you perform the phalen’s test? Tinel’s sign?

Answer 7

place each hand dorsum against each other

percuss median nerve at carpal tunnel in wrist - not as sensitive.

Question 8

Diagnostic testing for carpal tunnel syndrome?

Answer 8

• nerve conduction testing prior to orthopedic surgery consult

Question 9

Tx for carpal tunnel syndrome

Answer 9

• short term NSAIDS
• PT
• ergonomic modifications to workspace
• wrist splint at night
• orthopedic surg consult if pt fails other tx: steroid injection, carpal tunnel release