Carpal Tunnel Syndrome

Question 1

Nerve

Answer 1

Compression of Median Nerve

Question 2

Aetiology

Answer 2

Decrease space in tunnel: RA
Increased susceptibility of nerves to pressure: DM
Pregnancy
Acromegaly

Question 3

Symptoms

Answer 3

Numbness, paraesthesia, pain in palmar aspect of thumb, first and second fingers
Worse at night
Worse when holding a newspaper, telophone, steering wheel

Question 4

Signs

Answer 4

Sensory impairment first three fingers

Weakness of APB

Question 5

Tinel’s sign

Answer 5

Tapping distal wrist crease causes paraesthesiae in median nerve distribution

Question 6

Phalen’s sign

Answer 6

Sustained flexion of wrist at 90deg for 60s results in paraesthesiae.

Question 7

Flick sign

Answer 7

Patient makes flicking movement of wrist to alleviate symptoms

Question 8

Investigations

Answer 8

U:-
B: T4, glucose, FBC, CRP
S: NCS/EMG

Question 9

Diagnosis

Answer 9

Nerve conduction studies

EMG

Question 10

Management

Answer 10

Wrist splints
Intracarpal injection of corticosteroid
Oral steroids
Surgery