Carpal tunnel syndrome

Question 1

What is carpal tunnel syndrome, and what symptoms does it result in?

Answer 1

Compression of the median nerve as it travels through the carpal tunnel, causing pain and numbness in the median nerve distribution on the hand

Question 2

1) What is the commonest cause of carpal tunnel syndrome?
2) Name 3 other risk factors

Answer 2

1) Idiopathic
2) Obesity, rheumatoid arthritis, acromegaly, repetitive strain, diabetes, hypothyroidism

Question 3

How does carpal tunnel syndrome initially present?

Answer 3

Gradual onset of intermittent symptoms that are typically worse at night

Question 4

1) Carpal tunnel syndrome causes sensory symptoms in the distribution of what branch of the median nerve?
2) This impacts the palmar aspect and fingertips of what 3 areas?
3) Name 2 of the sensory symptoms that may be felt
4) Motor symptoms of carpal tunnel syndrome impact what muscles?

Answer 4

1) Palmar digital cutaneous branch
2) Thumb, index and middle finger, and lateral half of the ring finger
3) Numbness, paraesthesia (pins and needles or tingling), burning sensation, pain
4) Thenar muscles

Question 5

What are the 2 special tests for carpal tunnel syndrome, and what 2 symptoms do they test for (or is seen in a positive result)?

Answer 5

Phalen’s test and Tinel’s test - numbness and paresthesia

Question 6

What is the primary investigation for diagnosing carpal tunnel syndrome?

Answer 6

Nerve conduction studies

Question 7

Name a management option for carpal tunnel syndrome

Answer 7

• Rest and alter activities
• Wrist splint that maintain a neutral position of the wrist for the night
• Steroid injections
• Surgery - flexor retinaculum division