Carpal tunnel syndrome

Question 1

Define carpal tunnel syndrome

Answer 1

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

Question 2

What are the nerve roots of the median nerve?

Answer 2

C6-T1

Question 3

What are causes of carpal tunnel syndrome?

Answer 3

→ Swelling of the carpal tunnel contents - swelling of the tendon sheaths due to repetitive strain
→ Narrowing of the tunnel
→ most cases idiopathic

Question 4

What are risk factors of carpal tunnel syndrome?

Answer 4

→ Repetitive strain
→ Obesity
→ Perimenopause
→ Rheumatoid arthritis
→ Diabetes
→ Acromegaly
→ Hypothyroidism
→ Female
→ Pregnancy

Question 5

How do the symptoms of carpal tunnel syndrome present?

Answer 5

Gradually

Question 6

What are motor signs and symptoms of carpal tunnel syndrome?

Answer 6

→ Weakness of thumb movements
→ Weakness of grip strength
→ Difficulty with fine movements involving the thumb
→ Wasting of the thenar muscles (muscle atrophy)

Question 7

What are sensory signs and symptoms of carpal tunnel syndrome?

Answer 7

→ Numbness
→ Paraesthesia (pins and needles or tingling)
→ Burning sensation
→ Pain
→ worse at night

Question 8

How do you diagnose carpal tunnel syndrome?

Answer 8

→ Special tests - Phalen’s and Tinel’s test
→ nerve conduction studies
→ EMG diagnostic if above uncertain

Question 9

What is Phalen’s test?

Answer 9

Flex fist for 1 minute = +ve if paraesthesia and pain at wrist

Question 10

What is Tinel test?

Answer 10

Tapping on wrist causes tingling

Question 11

How do you treat carpal tunnel syndrome?

Answer 11

→ Rest and altered activities
→ Wrist splints that maintain a neutral position of the wrist,can be worn at night (for a minimum of 4 weeks) + Steroid injections
→ Last resort = surgical decompression