0071643192.pdf

ORTHOPEDICS

Carpal Tunnel Syndrome

A compressive neuropathy of the median nerve at the level of the carpal tunnel

in the volar aspect of the wrist

■ Most common peripheral compressive neuropathy

■ Lifetime risk of acquiring carpal tunnel syndrome is 10%.

■ More common in females than males

■ Often found in patients with repetitive strain of the hands and wrists, eg,

typists, musicians, etc.

■ Patients often have associated trauma, obesity, TB, renal failure, hypo-

thyroidism, or diabetes.

SYMPTOMS

■ Gradual onset and progression

■ Usually bilateral but may begin first in dominant hand

■ Early, paresthesias in median nerve distribution (palmar aspect of first

three digits and radial half of the fourth digit)

■ Late, persistent pain present, atrophy of thenar muscles

EXAM

■ Durkin’s compression test: Reproduction of symptoms with compression

of carpal tunnel for 30 seconds

■ Phalen’s sign: Reproduction of symptoms with hyperflexion of wrist at 90°

for 1 minute

■ Tinel’s sign: Pins-and-needles sensation in the median nerve distribution

with tapping on the carpal tunnel

■ Flick sign: Shaking or “flicking” the hands provides relief of symptoms

during episodes

■ Weakness of resisted thumb abduction

■ Thenar atrophy may be present late in disease.

■ Decreased sensation in median nerve distribution

DIFFERENTIAL

Brachial plexus compressive neuropathy, peripheral neuropathy of other causes

DIAGNOSIS

■ Usually a clinical diagnosis

■ Electromyography (EMG) and nerve conduction studies establish severity

of disease.

TREATMENT

■ NSAIDs

■ Volar splint in neutral position

■ Local steroid injection

■ Surgery for release of the transverse carpal ligament

COMPLICATIONS

Chronic pain, weakness, paresthesias, and disability

Positive Durkin’s compression

test, Phalen’s sign, Tinel’s sign,

and Flick sign are all

indicative of carpal tunnel

syndrome.