Carpal Tunnel Syndrome

Question 1

What is carpal tunnel syndrome (CTS)?

Answer 1

It is defined as a condition in which there is compression of the median nerve in the carpal tunnel of the wrist

Question 2

What is the most common compression neuropathy of the upper limb?

Answer 2

Carpal Tunnel Syndrome

Question 3

What is the pathophysiological cause of carpal tunnel syndrome?

Answer 3

The compression is related to either a reduced volume or increased pressure within the carpal tunnel

Question 4

What twelve risk factors are associated with carpal tunnel syndrome?

Answer 4

Middle Aged, 45 – 64 Years Old

Female Gender

Wrist Fractures

Repetitive Strain Injuries

Rheumatoid Arthritis

Ganglion Cysts

Diabetes Mellitus

Hypothyroidism

Pregnancy

Menopause

Smoking

Obesity

Question 5

Which condition is most commonly associated with carpal tunnel syndrome?

Answer 5

Rheumatoid Arthritis

Question 6

What are the five clinical features of carpal tunnel syndrome?

Answer 6

Paraesthesia of Thumb, Index & Middle Finger

Pain of Thumb, Index & Middle Finger

Reduced Grip Strength

Weak Thumb Abduction

Wasting Thenar Eminence

Question 7

Describe the pain associated with carpal tunnel syndrome

Answer 7

Gradual Onset

Nocturnal

Intermittent

Relief Through Shaking/Flicking Hand

Question 8

What four investigations are used to diagnose carpal tunnel syndrome?

Answer 8

Phalen’s Test

Tinel’s Test

Electromyography (EMG)

Nerve Conduction Studies

Question 9

How is the Phalen’s test conducted?

Answer 9

It involves asking individuals to hold their wrist in maximum forced flexion, by pushing the dorsal surfaces of both hands together, for a period of 60 seconds

Question 10

What is a positive Phalen’s test?

Answer 10

It is indicated by pain or paraesthesia in the median nerve distribution during this manoeuvre

Question 11

How is the Tinel’s test conducted?

Answer 11

It involves the examiner taping over the patient’s carpal tunnel with their finger

Question 12

What is a positive Tinel’s test?

Answer 12

It is indicated by pain or paraesthesia in the median nerve distribution during this manoeuvre

Question 13

What is electromyography (EMG)?

Answer 13

It measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle

Question 14

What electromyography result indicates carpal tunnel syndrome?

Answer 14

Prolonged action potentials in both sensory and motor nerve axons

Question 15

What are nerve conduction studies?

Answer 15

They measure how fast an electrical impulse is transmitted through the nerve

Question 16

What nerve conduction study result indicates carpal tunnel syndrome?

Answer 16

Reduced median nerve conduction velocity

Question 17

When is conservative management used to treat carpal tunnel syndrome?

Answer 17

It is the first line management option used to treat mild to moderate disease

Question 18

How long should conservative management of carpal tunnel syndrome be trialled for before surgical management is considered?

Answer 18

6 weeks

Question 19

What are the two conservative management options used to manage carpal tunnel syndrome?

Answer 19

Wrist Rest

Nocturnal Wrist Splinting

Question 20

When is pharmacological management used to treat carpal tunnel syndrome?

Answer 20

It is the second line management option used to treat mild to moderate disease

Question 21

What is the pharmacological management option of carpal tunnel syndrome?

Answer 21

Corticosteroid Injections

Question 22

How are corticostreoid injections used to treat carpal tunnel syndrome?

Answer 22

They can be used to provide symptomatic relief for a period of four weeks

Question 23

When is surgical management used to treat carpal tunnel syndrome?

Answer 23

It is used to treat severe disease, or when non-surgical management options are deemed ineffective

Question 24

What is the surgical management option of carpal tunnel syndrome?

Answer 24

Flexor Retinaculum Division

Question 25

What is flexor retinaculum division?

Answer 25

It involves an incision to the flexor retinaculum, which is the roof of the carpal tunnel, in order to relieve pressure on the median nerve