Carpal Tunnel Syndrome

Question 1

Define Carpal Tunnel Syndrome?

Answer 1

Carpal Tunnel Syndrome refers to the symptom complex brought on by compression of the median nerve in the carpal tunnel

Question 2

What is the aetiology of Carpal Tunnel Syndrome?

Answer 2

Symptoms are caused by compression of the median nerve as it runs through the carpal tunnel
Usually IDIOPATHIC

Question 3

What may Carpal Tunnel Syndrome be secondary to?

Answer 3

Tenosynovitis (e.g. in the rheumatoid arthritis)
Infiltrative diseases of the canal/increased soft tissue (e.g. amyloidosis, acromegaly)
Bone involvement in the wrist (e.g. osteoarthritis, fracture)
Fluid retention states (e.g. pregnancy, nephrotic syndrome)
Other (e.g. obesity, menopause, diabetes)

Question 4

What is the epidemiology of Carpal Tunnel Syndrome?

Answer 4

Prevalence: 2.7%

Lifetime risk of 10%

Question 5

What are the presenting symptoms of Carpal Tunnel Syndrome?

Answer 5

Tingling and pain in the hand and fingers

Weakness and clumsiness of the hand

Question 6

What are the signs of Carpal Tunnel Syndrome?

Answer 6

Sensory impairment in the median nerve distribution
Weakness and wasting of thenar eminence
Tinel’s Sign
Phalen’s Test
Look out for signs of the underlying cause (e.g. acromegaly, hypothyroidism)

Question 7

What is Tinel’s Sign?

Answer 7

Tapping the carpal tunnel causes symptoms

Question 8

What is Phalen’s Test?

Answer 8

Flexion of the wrist for 1 min may cause symptoms

Question 9

What bloods do we do for Carpal Tunnel Syndrome?

Answer 9

TFTs

ESR

Question 10

Why do we do a Nerve Conduction Study for Carpal Tunnel Syndrome?

Answer 10

Not usually necessary

Shows impaired median nerve conduction across the carpal tunnel