Carpal tunnel syndrome

Question 1

What is it?

Answer 1

Compression of the medial nerve as it passes through the carpal tunnel

Question 2

What are the risk factors

Answer 2

Mostly idiopathic
- Repetitive strain
- obesity
- perimenopausal
- RA
- Diabetes
- acromegaly
- hypothyroidism

Question 3

what is a key cause of bilateral CTS?

Answer 3

acromegaly

Question 4

Presentation

Answer 4

Sensory, affects:
palmar aspect and full thickness of the thumb, index and middle finger, lateral half of ring finger
Pt may describe trying to shake their hand to relieve sx

Motor sx:
Weakness of thumb movements
Weakness of grip strength
Difficulty with fine movements involving thumb
Wasting of thenar muscles

Question 5

What are the special tests for diagnosis?

Answer 5

Phalen’s
Put backs of hands together with wrists bent inwards at 90 degrees
Tinels:
tapping wrist where median nerve travels through tunnel, if reproduces numbness and paraesthesia - positive

Question 6

What is the primary investigation?

Answer 6

nerve conduction studies

Question 7

What is management?

Answer 7

Rest
Wrist splints
Steroid injections
Surgery - cutting flexor retinaculum to release pressure