Carpal Tunnel Syndrome

Question 1

What is carpal tunnel syndrome ( CTS )

Answer 1

Condition involving the compression of the median nerve due to raised pressure in this compartment

Question 2

What are the risk factors of CTS

Answer 2

Female gender

Increasing age

Pregnancy

Obesity

Previous injury to the wrist

Occupations where there are repeating hand/ wrist movements

Question 3

what are the clinical features of CTS

Answer 3

Pain, numbness, paraesthesia over the median nerve sensory distribution

Palm is spared as the branches to the palm are given off before the flexor retinaculum

Sx worse at night and relieved by hanging hand out of the bed

Later stages => weakness in thumb abduction/ wasting in thenar eminence muscles

Question 4

What tests can be carried out for carpal tunnel syndrome

Answer 4

Tinel’s test - percussion over the median nerve

Phalens test - holding the wrist in full flexion for one min

Question 5

What are the differential diagnosis

Answer 5

Cervical radiculopathy - C6 nerve root compression => causes similar symptoms

Pronator teres Syndrome - median nerve compressed by pronator teres

Flexor carpi radialis tenosynovitis

Question 6

What are the investigations you would carry out

Answer 6

Clinical diagnosis largely

In uncertain cases you could do nerve conduction studies

Question 7

How would you manage CTS conservatively

Answer 7

Wrist splint

Corticosteroid injections

Question 8

How would you manage CTS surgically

Answer 8

Carpal tunnel release surgery - cutting through the flexor retinaculum

Question 9

What are the complications of surgery

Answer 9

Persistent symptoms

Infection

Scar

Nerve damage

Trigger thumb

Question 10

What are the long term untreated complications of CTS

Answer 10

neurological impairment