carpal tunnel syndrome

Question 1

definition

Answer 1

Carpal tunnel syndrome (CTS) is a collection of symptoms and signs caused by compression of the median nerve in the carpal tunnel. Typical symptoms include numbness and tingling mainly in the thumb and radial fingers, aching and pain in the anterior wrist and forearm, and clumsiness in the hand.
most common entrapment neuropathy (1 in 25)

Question 2

signs and symptoms

Answer 2

• numbeness of hand
• worsening at night time
• numbness in median nerve distribution (index and middle finger)
• intermittent symptoms
• gradual onset
• weakness of hand
• clumsiness
• aching and pain in arm (radiating from wrist upwards toward forearm)
• weakness of thenar muscles (test for abduction of thumb to 90 degrees to index)
• normal reflexes

Question 3

risk factors

Answer 3

• over 30 y/o
• high BMI
• female
• alterations in carpal tunnel space
• fractured wrist/carpal bones
• square wrist
• RA
• diabetes
• dialysis
• pregnancy
• congenital carpal tunnel stenosis
• occupational hazards
• use of mobility aids

Question 4

investigations

Answer 4

1st investigation:
EMG (slowing of conduction across median nerve in carpal tunnel)

• wrist ultrasound, MRI

Question 5

classification of severity by EMG

Answer 5

electromyogram (EMG) classification of severity
Mild disease: sensory nerve abnormalities with no axonal loss
Moderate disease: sensory and motor nerve abnormalities but with no axonal loss
Severe disease: any evidence of axonal loss in sensory or motor nerves.