Carpal Tunnel

Question 1

define carpal tunnel

Answer 1

distal pain, numbness and weakness from median nerve entrapment and compression at the wrist

Question 2

which nerve is involved in carpal tunnel

Answer 2

median

Question 3

where do people experience carpal tunnel pain

Answer 3

palmar aspects of thumb, index finger, middle finger and radial aspect of 4th finger

nocturnal

relief attempted by shaking fingers

pain may radiate up forearm

aggravated by activity

Question 4

how does carpal tunnel weakness present

Answer 4

grasping and pinching is difficult

possible thenar atrophy

Question 5

what causes carpal tunnel

Answer 5

repetitive trauma

systemic diseases

rule out cervical abnormality and underlying conditions

Question 6

what systemic diseases can cause carpal tunnel

Answer 6

diabetes
RA
pregnancy
hypothyroid
hyperparathyroid
amyloidosis
sarcoidosis
acromegaly
AV dialysis shunt

Question 7

physical exam for carpal tunnel

Answer 7

exam for atrophy of the thenar group

pinprick and light touch over hand

Phalens test

Tinels sign

examine neck for abnormalities

Question 8

what is phalen’s test

Answer 8

30-60 seconds of wrist flexion exagerrates or reproduces pain

Question 9

what is tinels sign

Answer 9

paresthesias or pain when tapping on the carpal tunnel

Question 10

what investigations should be done for carpal tunnel

Answer 10

clinical diagnosis

can consider nerve conduction studies or blood work for other etiologies

Question 11

treatment of carpal tunnel

Answer 11

rest, modify hand activity

splinting

NSAIDs

steroid injection

surgical decompression

treat underlying conditions