Carpal tunnel syndrome

Question 1

What is the definition of carpal tunnel syndrome?

Answer 1

A compression neuropathy of medial nerve as it passes under the transverse carpal ligament (through carpal tunnel) at the level of the wrist

Question 2

What kind of condition is carpal tunnel syndrome?

Answer 2

Peripheral nerve entrapment/compression neuropathy

Question 3

What is the most common form of compressive neuropathy in the general population?

Answer 3

Carpal tunnel syndrome

Question 4

What is the estimated ratio of men to women with carpal tunnel syndrome?

Answer 4

1:3

Question 5

What percentage of the general population is affected by carpal tunnel syndrome?

Answer 5

3.8%

Question 6

What percentage range of the European population is affected by carpal tunnel syndrome?

Answer 6

1-7%

Question 7

What age range of individuals are most commonly affected by carpal tunnel syndrome?

Answer 7

30-60 years old

Question 8

What age range of women are most commonly affected by carpal tunnel syndrome?

Answer 8

40-60 years old

Question 9

In carpal tunnel syndrome, what parts of the hand do symptoms typically present in?

Answer 9

Thumb and 3.5 digits on radial side: index finger, middle finger, radial half of ring finger

Question 10

In carpal tunnel syndrome, is the little finger affected?

Answer 10

No

Question 11

What 3 sensations affect an individual with short-term carpal tunnel syndrome?

Answer 11

Pain

Paranesthesia: tingling and prickling sensation (pins and needles)

Dysesthesia: abnormal sensation felt when the affected area is touched

Question 12

Do individuals with carpal tunnel syndrome typically present with nocturnal symptoms?

Answer 12

Yes, individual commonly wakes up at night to shake pins and needles out of hand or dangle hand

Question 13

In long-term carpal tunnel syndrome, what muscle wasting occurs and how does this present in physical examination in 2 ways?

Answer 13

Thenar muscle wasting causes reduced/weak thumb abduction and thumb opposition

Question 14

What 2 symptoms commonly present in long-term carpal syndrome other than thenar muscle wasting?

Answer 14

Hypoesthesia (reduced sensation)

Anaesthesia (no sensation)

Question 15

What 3 special tests are positive in carpal tunnel syndrome?

Answer 15

Phalen’s test/reverse Phalen’s

Durkin’s compression test

Tinel’s test

Question 16

What is the Tinel’s test and its positive result?

Answer 16

Tapping lightly over median nerve causes paresthesia (tingling and pricking sensation)

Question 17

What is the Phalen’s/reverse Phalen’s test and its positive result?

Answer 17

Keep both wrists flexed for at least 30 seconds, causes numbness/tingling in fingers or hands

Question 18

What is the Durkin’s compression test and its positive result?

Answer 18

Flex wrist and put pressure on carpal tunnel for 30 seconds, causes numbness, pain or tingling in thumb and 3.5 radial digits

Question 19

Is radiological investigation needed to diagnose carpal tunnel syndrome?

Answer 19

No, diagnosis is usually just clinical but radiological imaging can be used if patient presents with unusual symptoms

Question 20

What 2 mediums of radiological imaging are used to confirm carpal tunnel syndrome diagnosis and why?

Answer 20

MRI and ultrasound imaging are used to see abnormalities of median nerve and surrounding soft tissue

Question 21

Explain 2 Electrodiagnostic/ neurophysiological studies that can be done to determine extent of median nerve damage in carpal tunnel syndrome?

Answer 21

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

Question 22

Give 5 examples of less invasive treatments that are initially offered for carpal tunnel syndrome management?

Answer 22

education/watchful wait

activity and work modification

splinting for wrist support to avoid flexion

simple analgesics

physiotherapy

Question 23

When is corticosteroid injection considered for carpal tunnel syndrome management?

Answer 23

Offered for pain relief if less invasive treatments have insufficient effect

Question 24

When is carpal tunnel release surgery considered, and what is it

Answer 24

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

Question 25

Give 4 statistics for post-operative recovery from carpal tunnel release surgery?

Answer 25

50% cases have full recovery, 30% are much better after surgery, 10% slightly better after surgery, 6% cases worse after surgery

Question 26

What is the differential diagnosis of carpal tunnel syndrome?

Answer 26

Double crush syndrome: 2 sites of nerve entrapment along same peripheral nerve

Question 27

How can you disprove double crush syndrome and confirm carpal tunnel syndrome diagnosis?

Answer 27

Ask if patient also has shoulder and neck problems as these indicate double crush syndrome

Question 28

Give 2 locations of possible median nerve entrapment other than under carpal tunnel?

Answer 28

Possible entrapment between 2 heads of pronator teres near elbow

Possible entrapment under ligament of Struthers

Question 29

Give examples of conditions that are associated with carpal tunnel syndrome?

Answer 29

Rheumatoid arthritis
Hypothyroidism
Diabetes Mellitus
Acromegaly
Osteophytes, ganglia
Wrist trauma
Space occupying lesions
Synovitis of the flexor tendons (for example rheumatoid arthritis)
Amyloidosis
Pregnancy

Question 30

Is carpal tunnel syndrome usually bilateral, if so what hand is most affected?

Answer 30

Usually bilateral, affects dominant hand more