A Simple Guide to Carpal Tunnel Syndrome

A Simple Guide to Carpal Tunnel Syndrome
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What is Carpal Tunnel Syndrome?
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Carpal Tunnel Syndrome is the compression of the median nerve in the carpal tunnel of the wrist.
The carpal tunnel is a ligamentous sheath which provides protection for the median nerve as it travels across the carpal bones in the wrist.

What are the causes of Carpal Tunnel Syndrome?
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Carpal Tunnel Syndrome occur as a result of pressure on the median nerve between the tranverse carpal ligament and the flexor tendons with their inflammed and enlarged synovium.

Local causes:
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trauma including injury,fractures

tenosynovitis(inflammation of the tendon and their synovial sheath)

lipoma

ganglion

Systemic causes:
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polyarthritis

myxedema (hypothyroidism)

pregnancy( due to fluid retention)

Amyloid disease

What are the symptoms and signs of Carpal Tunnel Syndrome?
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The onset is usually spontaneous with gradual increasing night pains which causes the patient to seek treatment:

1.Painful night tingling sensation of the fingers which can extend to the forearm-relieved by hanging the arm down or shaking

2.Parethesia and numbness of the index, middle and ring finger

3.Fingers feel clumsy

4.thenar muscle wasting and weakness may be present

5.impairment of light touch and pin prick sensation on the 3 middle fingers

6.women are more affected than men



What are the investigations required in Carpal Tunnel Syndrome?
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1.Physical examination

Phalen's test-
flex wrists so that the dorsal surfaces of the hands are in full contact with each other, hold for 1 min: tingling and numbness in median nerve distribution

Reverse Phalen's test(prayer Sign)-
extend wrists so that the palms of hands are in full contact like in prayer, hold for 1 min: tingling and numbness in median nerve distribution

Tinel's test -
tap volar surface of the wrist:tingling means positive test

2.EMG - electromyography to test movement of the muscles

3.Nerve conduction tests on median nerve

What is the treatment of Carpal Tunnel Syndrome?
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1.Treat underlying conditions such as myxedema, polyarthritis,amyloid

2.diuretic in mild cases and those present in pregnant women

3.NSAIDS may reduce inflammation.

4.wrist splintage in extension

5.injection of the carpal tunnel with corticosteroid (avoiding the carpal nerve)

6.Surgical decompression by division of the transverse carpal ligament.
Results are usually good.