Carpal tunnel syndrome

Question 1

What is carpal tunnel syndome?

Answer 1

Compression of the median nerve through the carpal tunnel

Question 2

What is carpal tunnel syndrome due to broadly?

Answer 2

Swelling of the contents (e.g., swelling of the tendon sheaths due to repetitive strain)

Narrowing of the tunnel

Question 3

Risk factors for carpal tunnel syndrome

Answer 3

Most cases - it is idiopathic - no clear cause found

Risk factors include:
Repetitive strain
Obesity
Perimenopause
Rheumatoid arthritis
Diabetes
Acromegaly
Hypothyroidism

Question 4

Presentation of carpal tunnel syndrome

Answer 4

Sensory symptoms in the distribution of the palmar digital cutaneous branch of the median nerve
- Thumb, index, middle and half of ring finger

Numbness
Paraesthesia (pins and needles or tingling)
Burning sensation
Pain

Motor symptoms of thenar muscles:

• Weakness of thumb movements
• Weak grip strength
• Difficulty with fine movements involving the thumb
• Wasting of the thenar muscles (muscle atrophy)

Question 5

Special tests for carpal tunnel syndrome

Answer 5

Phalen’s

Tinnel’s

Question 6

Examinations and investigations for carpal tunnel syndrome

Answer 6

Examinations - hand exam with Tinels and Phalens, neurovascular assessment of upper limb/hand

Nerve conduction studies are the primary investigation for establishing the diagnosis.
- Demonstrates how well signals are passing through the carpal tunnel along the median nerve.

Question 7

Management of carpal tunnel

Answer 7

Rest and altered activities

Wrist splints that maintain a neutral position of the wrist can be worn at night (for a minimum of 4 weeks)

Steroid injections

Surgery - flexor retinaculum cut to release the pressure on median nerve. Open or endoscopic (scar will be vertical and straight if open)