Carpal Tunnel Syndrome

Question 1

Define Carpal Tunnel Syndrome

Answer 1

> Median nerve compression (most common peripheral nerve entrapment syndrome)
> Due to: 
- oedema
- tendon inflammation
- hormonal changes
- manual activity

Question 2

Risk factors

Answer 2

> Female 
> Diabetes
> menopause
> hyperthyroidism
> obesity
> arthritis
> pregnancy

Question 3

Clinical presentation

Answer 3

> Intermittent nocturnal paraesthesia (changes in sensation e.g pins + needs, numbness etc)
- will increase in frequency until develops into waking hours
Loss of sensation
weakness of median nerve innervated muscles + eventually atrophy (severe cases)
Pain
Difficulty with motor tasks (severe cases)
*Symptoms are likely to follow path of median nerve but may spread over larger area

Question 4

Diagnosis

Answer 4

> Rule out cervical radiculopathy (compression of nerve at spine)
Tinel’s sign (tapping median nerve to cause pins and needles in nerve distribution)
Phalen’s sign (wrist is flexed for one minute to reproduce symptoms)

Question 5

Prognosis + Management

Answer 5

> Mild/Moderate cases will generally benefit from conservative treatment
Severe Cases may need surgery

General management:
> Education
> load management
> Splinting (particularly at night)
> exercise
> corticosteroid injection
> surgery