Carpal Tunnel Syndrome

Question 1

What is CTS?

Answer 1

Condition of compression of median nerve within carpal tunnel of wrist

Question 2

What are the risk factors for CTS? (9 things)

Answer 2

1. Female
2. Age
3. Pregnancy
4. Obesity
5. Prev wrist injury
6. DM
7. RA
8. Hyperthyroidism
9. Occupation w repetitive hand movement

Question 3

What are the clinical features for CTS? (5 things)

Answer 3

1. Pain
2. Numbness
3. Paraesthesia
4. Thumb abduction weakness (late)
5. Thenar eminence wasting (late)

Question 4

Why do you get Thumb abduction weakness as a late presentation in CTS?

Answer 4

Bc Palmar Cutaneous Branch of Median nerve branches prox to Flexor Retinaculum n passes OVER Carpal Tunnel

Question 5

When are CT symptoms worse?

Why?

Answer 5

At night

Bc hand is compressed in bed

Question 6

How can night symptoms of CT be relieved? (2 things)

Answer 6

1. Hang arm over side of bed

2. Shake hand back n forth

Question 7

What are the special tests for CTS? (2 things)

Answer 7

Tinels Test (tap median nerve)
Phalens test (hold wrist in flexion for 1 min)

Question 8

What are the differentials of CTS? (3 things)

Answer 8

1. Cervical Radiculopathy
2. Pronator teres syndrome
3. Flexor carpi radialis tenosynovitis

Question 9

How is Cervical Radiculopathy similar to CTS?

Answer 9

C6 nerve root involvement –> pain / paraesthesia in similar distribution

Question 10

How do you differentiate between Cervical Radiculopathy and CTS? (2 things)

Answer 10

1. CR = neck pain

2. Entire arm symptoms

Question 11

How is Pronator teres syndrome similar to CTS?

Answer 11

Median nerve compression, but by pronator teres

Question 12

How do you differentiate between Pronator teres syndrome and CTS?

Answer 12

1. PTS = symptoms extend to prox forearm

2. Reduced palm sensation

Question 13

How do you differentiate between Flexor Carpi Radialis Tenosynovitis and CTS?

Answer 13

FCRT = tenderness @ base of thumb

Question 14

How is a diagnosis of CTS made?

Answer 14

Clinically

Question 15

What investigations can be done to confirm a diagnosis of CTS?

Answer 15

Electrophysiology (to check prolongation of AP)

Question 16

What are the conservative management options for CT? (2 things)

Answer 16

1. Wrist splint @ night

2. Physio

Question 17

What is the benefit of having a Wrist Splint for CT? (2 things)

Answer 17

1. Prevents wrist flexion

2. Holds wrist to not exacerbate pain + tingling

Question 18

What is the medical management option for CT?

Answer 18

Corticosteroids inj (inj directly into CT)

Question 19

What are the indications for CT surgery?

Answer 19

Severely limiting

Question 20

Wht is the surgery for CT? (3 points)

Answer 20

1. Decompression surgery
2. Cut through Flexor Retinaculum –> reduces pressure on median n
3. Under local

Question 21

What are the complications of CT Surgery?

Answer 21

1. Persistent CTS symptoms
2. Infection
3. Scar formation
4. Nerve damage
5. Trigger thumb?