carpal tunnel syndrome

Question 1

what is carpal tunnel syndrome

Answer 1

collection of symptoms and signs caused by compression of the median nerve in the carpal tunnel at the wrist

Question 2

name of the tendons in the carpal tunnel

Answer 2

The tendon of flexor pollicis longus
Four tendons of flexor digitorum profundus
Four tendons of flexor digitorum superficialis

Question 3

name of the two branches of the median nerve

Answer 3

recurrent branch and palmar digital nerves.

Question 4

recurrent branch supply

Answer 4

thenar muscle group.

Question 5

palmar digital nerves supply

Answer 5

sensory innervation to the palmar skin and dorsal nail beds of the lateral three and a half digits.

motor innervation to the lateral two lumbricals.

Question 6

causes of carpal tunnel syndrome

Answer 6

• Activities with high hand/wrist repetition rate.
• Obesity
• Peri-menopause.
• Osteoarthritis and rheumatoid arthritis.
• Psychosocial factors such as low mood.
  Distal upper limb tendinopathies and tendonitis.
• Vibration.
• Hypothyroidism.
• Diabetes mellitus.
• Acromegaly.
• Space occupying lesions including osteophytes and ganglion cysts.
• Wrist trauma.

Question 7

complications of carpal tunnel syndrome

Answer 7

• difficulties with activities of daily life (including work) and sleep due to symptoms of pain, sensory disturbance, weakness and impaired fine manipulation.
• segmental demyelination and ultimately axonal loss.

Question 8

symptoms of carpal tunnel syndrome

Answer 8

• intermittent tingling, numbness or altered sensation and burning or pain in the distribution of the median nerve (the thumb, index finger, middle finger, and radial half of the ring finger).
• Symptoms are often worse at night and can disrupt sleep.
• Symptoms may affect one or both hands.
• Pain in the hand may radiate up the arm into the wrist or as far as the shoulder.
• The person may complain of loss of grip strength, clumsiness and reduced manual dexterity for example when doing up buttons.
• Some people may present atypically, for example, they may have sensory changes in all digits.
• Severe disease may cause unremitting sensory symptoms, weakness or thenar muscle wasting.
• relieving factor - shaking or flicking the wrist

Question 9

examination signs of carpal tunnel syndrome

Answer 9

• Sensory loss in the distribution of the median nerve.
• Atrophy of the muscles of the thenar eminence.
• Reduced strength of thumb abduction.
• Dry skin on the thumb, index, and middle fingers – trophic ulcers at the tips of the digits may be present.

Question 10

carpal tunnel tests

Answer 10

phalens - flex wrist pain and paraesthesia 60s
tinel - tapping lightly over the median nerve
carpal tunnel compression test (Durkan) -

Question 11

DD for carpal tunnel syndrome

Answer 11

• Cervical radiculopathy - neck pain or symptoms involving the entire arm length
• pronator teres syndrome - sensation of palm reduced
• Ulnar nerve compression.
• De Quervains tenosynovitis - sore at the base of thumb
• Lateral epicondylitis.
• Osteoarthritis or inflammatory arthritis.
• Vibration white finger or hand-arm vibration syndrome.
• Raynaud’s phenomenon.
• Neuropathy due to conditions such as diabetes mellitus, hypothyroidism, and B12 deficiency.
• Motor neurone disease.
• Multiple sclerosis.
• Stroke.

Question 12

management for carpal tunnel

Answer 12

wrist splinting

corticosteroids

Question 13

surgical treatment for carpal tunnel syndrome

Answer 13

Carpal tunnel release surgery (Fig. 4) decompresses the carpal tunnel, involving cutting through the flexor retinaculum, in turn reducing the pressure on the median nerve. This can be done under local anaesthetic and is performed as a day case.

Question 14

complciations of carpal tunnel surgery

Answer 14

• persistent CTS symptoms (from incomplete release of ligament)
• infection
• scar formation
• nerve damage
• trigger thumb.