Carpel tunnel syndrome

Question 1

what is the carpal tunnel

Answer 1

formed by the carpal bones inferiorly and the flexor retinaculum superiorly

Question 2

what is the flexor retiniculum also known as

Answer 2

transverse carpal ligament

Question 3

what passes through the carpal tunnel

Answer 3

• the median nerve

- the 9 flexor tendons: 1 flexor policis longus, flexor digitorum superficialis, 4 flexor digitorum profundus

Question 4

what is carpal tunnel syndrome

Answer 4

nerve entrapment disorder caused by compression of the median nerve as it passes through the carpal tunnel

Question 5

what are most cases of carpal tunnel syndrome

Answer 5

idiopathic

Question 6

what can cause carpal tunnel syndrome

Answer 6

• repetitive strain injury (typing) which explains why symptoms are sowers at night after a day of overuse
• rheumatoid arthritis (the flexor tendons are covered in synovium so can become inflamed)
• pregnancy
• diabetes
• chronic renal failure
• hypothyroidism

Question 7

carpal tunnel syndrome can also results as a consequence of what

Answer 7

wrist fractures particularly colles fracture

Question 8

who does carpal tunnel syndrome mostly affect

Answer 8

8x more common in woman

Question 9

presentation

Answer 9

• pain, parasthesia in the digits innervated by the median nerve: thumb, index finger, middle finger, radial half of the ring finger
• weakness and clumsiness involving the thumb

Question 10

when is the carpal tunnel syndrome pain worse

Answer 10

at night after a day of overuse

Question 11

in chronic cases

Answer 11

there may be loss of sensation and wasting of the thenar eminence because they are innervated by the recurrent branch of the median nerve which branches after it passes through the carpal tunnel (flexor policis, abductor policis, opponens policis)

Question 12

test for carpal tunnel syndrome

Answer 12

• tinnels test which involves percussing the median nerve

- phalens test where holding the wrist in a hyper flexed position for a minute reproduces symptoms

Question 13

diagnosis of carpal tunnel syndrome

Answer 13

nerve conduction studies

Question 14

non-surgical management of carpal tunnel

Answer 14

wrist saints at night to prevent flexion and steroid injectiosn

Question 15

surgical management of carpal tunnel syndrome

Answer 15

carpal tunnel decompression which involves dividing the flexor retinaculum under local anaesthetic

Question 16

why is the palm unaffected in carpal tunnel syndrome

Answer 16

it is innervated by the palmar branch of the median nerve which branches before the carpal tunnel and travels superficial to the carpal tunnel rather than through the carpal tunnel