Musculoskeletal System >
Carpal Tunnel Syndrome

“Peripheral neuropathy caused by compression of median nerve in carpal tunnel

Risk Factors
  • Manual work ( repetitive overuse- Flex/ext)
  • Advanced Age
  • Females
  • Pregnancy
  • Diabetes
  • Obesity
  • Rheumatoid Arthritis
  • Acromegaly
Aetiology
  • Idiopathic
Pathophysiology
  1. Increased pressure in carpal tunnel causes compression
  2. Impairment of blood flow
Clinical Presentation
  • Pain or tingling in arm/hand along median nerve
  • Loss of sensation/ numbness
  • Paraesthesia
  • Chronic cases can lead to muscle wasting of thenar eminence
  • Weakened pinch grip
  • Symptoms worse at night
Investigations
  • Hand and wrist examination
  • Provocative tests
    • Hand elevation test
    • Carpal compression test
    • Phalen’s test
    • Tinel’s sign
  • Confirmation of diagnosis by nerve conduction or electromyogram
Management
  • Conservative treatment
    • Immobilization and splinting of wrist and NSAIDs
    • Corticosteroid injection only if moderate to severe pain
  • Surgical
    • Severe cases: surgical decompression- release of transverse carpal ligament
Complications
  • Atrophy of thenar eminence

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