Carpal tunnel syndrome Flashcards
What is cubital tunnel syndrome?
Ulnar nerve entrapment at the elbow causing tingling of in the ulnar distribution
Define carpal tunnel syndrome?
Pain caused by compression of median nerve in the carpal tunnel.
What are the clinical features of carpal tunnel syndrome?
- pain/pins and needles in thumb, index, middle finger
- unusually the symptoms may ‘ascend’ proximally
- patient shakes his hand to obtain relief, classically at night
On examination:
- weakness of thumb abduction (abductor pollicis brevis)
- wasting of thenar eminence (NOT hypothenar)
- Tinel’s sign: tapping causes paraesthesia
- Phalen’s sign: flexion of wrist causes symptoms
What are the causes of carpal tunnel syndrome?
- idiopathic
- pregnancy
- oedema e.g. heart failure
- lunate fracture
- rheumatoid arthritis
What investigations may be done to diagnose carpal tunnel syndrome?
Usually clinical diagnosis
Nerve conduction studies may be done if diagnosis uncertain
What is the management of carpal tunnel syndrome?
NICE currently recommends a 6-week trial of conservative treatments if the symptoms are mild-moderate:
- corticosteroid injection
- wrist splints at night in neutral position
- hand exercises
If there are severe symptoms or symptoms persist with conservative management:
- surgical decompression (flexor retinaculum division)
What is the pathophysiology of carpal tunnel syndrome?
Ischaemia of the median nerve due to compression
