Carpal tunnel syndrome Flashcards
What is the definition of carpal tunnel syndrome?
A compression neuropathy of medial nerve as it passes under the transverse carpal ligament (through carpal tunnel) at the level of the wrist
What kind of condition is carpal tunnel syndrome?
Peripheral nerve entrapment/compression neuropathy
What is the most common form of compressive neuropathy in the general population?
Carpal tunnel syndrome
What is the estimated ratio of men to women with carpal tunnel syndrome?
1:3
What percentage of the general population is affected by carpal tunnel syndrome?
3.8%
What percentage range of the European population is affected by carpal tunnel syndrome?
1-7%
What age range of individuals are most commonly affected by carpal tunnel syndrome?
30-60 years old
What age range of women are most commonly affected by carpal tunnel syndrome?
40-60 years old
In carpal tunnel syndrome, what parts of the hand do symptoms typically present in?
Thumb and 3.5 digits on radial side: index finger, middle finger, radial half of ring finger
In carpal tunnel syndrome, is the little finger affected?
No
What 3 sensations affect an individual with short-term carpal tunnel syndrome?
Pain
Paranesthesia: tingling and prickling sensation (pins and needles)
Dysesthesia: abnormal sensation felt when the affected area is touched
Do individuals with carpal tunnel syndrome typically present with nocturnal symptoms?
Yes, individual commonly wakes up at night to shake pins and needles out of hand or dangle hand
In long-term carpal tunnel syndrome, what muscle wasting occurs and how does this present in physical examination in 2 ways?
Thenar muscle wasting causes reduced/weak thumb abduction and thumb opposition
What 2 symptoms commonly present in long-term carpal syndrome other than thenar muscle wasting?
Hypoesthesia (reduced sensation)
Anaesthesia (no sensation)
What 3 special tests are positive in carpal tunnel syndrome?
Phalen’s test/reverse Phalen’s
Durkin’s compression test
Tinel’s test
What is the Tinel’s test and its positive result?
Tapping lightly over median nerve causes paresthesia (tingling and pricking sensation)
What is the Phalen’s/reverse Phalen’s test and its positive result?
Keep both wrists flexed for at least 30 seconds, causes numbness/tingling in fingers or hands
What is the Durkin’s compression test and its positive result?
Flex wrist and put pressure on carpal tunnel for 30 seconds, causes numbness, pain or tingling in thumb and 3.5 radial digits
Is radiological investigation needed to diagnose carpal tunnel syndrome?
No, diagnosis is usually just clinical but radiological imaging can be used if patient presents with unusual symptoms
What 2 mediums of radiological imaging are used to confirm carpal tunnel syndrome diagnosis and why?
MRI and ultrasound imaging are used to see abnormalities of median nerve and surrounding soft tissue
Explain 2 Electrodiagnostic/ neurophysiological studies that can be done to determine extent of median nerve damage in carpal tunnel syndrome?
Nerve conduction velocity test, where electrode attached to elbow sends mild current down median nerve and the longer it takes for current to pass from elbow to fingers, the more damaged the median nerve
Electromyogram: measures function of muscle tissue surrounding median nerve
Give 5 examples of less invasive treatments that are initially offered for carpal tunnel syndrome management?
education/watchful wait
activity and work modification
splinting for wrist support to avoid flexion
simple analgesics
physiotherapy
When is corticosteroid injection considered for carpal tunnel syndrome management?
Offered for pain relief if less invasive treatments have insufficient effect
When is carpal tunnel release surgery considered, and what is it
Considered when there is clinical evidence of median nerve denervation
Ligament that is pressing down on the carpal tunnel is cut, which makes more room for the median nerve and tendons passing through the tunnel
