Carpal Tunnel Syndrome Flashcards
What causes carpal tunnel syndrome?
Compression of the median nerve in the carpal tunnel due to swelling of the contents or narrowing of the tunnel
What branch of the median nerve is responsible for sensory innervation of the palmar aspects and fingertips?
Palmar digital cutaneous branch
Why is sensation to the palm not affected in carpal tunnel syndrome?
Palmar cutaneous branch of the median nerve provides sensation to the palm
This branch originates before the carpal tunnel and does not travel through
Thus not affected in carpal tunnel syndrome
What muscles does the median nerve provide innervation to?
Lateral two lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
What are the risk factors for carpal tunnel syndrome?
Most cases it is idiopathic
- Repetitive strain
- Obesity
- Perimenopause
- Rheumatoid arthritis
- Diabetes
- Acromegaly
- Hypothyroidism
How does carpal tunnel syndrome present?
Intermittent symptoms, often worse at night
Sensory symptoms in the distribution of the palmar digital cutaneous branch of the median nerve e.g.
- Numbness
- Paraesthesia
- Burning
- Pain
What are the motor symptoms of carpal tunnel syndrome?
Affects the thenar muscles mainly
- Weakness of thumb movements
- Weaknsss of grip strength
- Fine movement difficulty with thumb
- Thenar atrophy
What special tests are used for carpal tunnel syndrome?
Phalen’s and Tinel’s
Tinel-Tapping
What questions are asked for patient’s with suspected carpal tunnel syndrome?
- Do symptoms wake you at night?
- Do you have movements to improve symptoms?
- Is your little finger affected? (Yes means less likely)
What is the primary investigation for carpal tunnel syndrome diagnosis?
Nerve conduction studies
What is the management of carpal tunnel syndrome?
Rest and altered activity
Wrist splints keeps neutral position of wrist (worn at night for 4 weeks)
Steroid injections
Surgery- (flexor retinaculum cut to release pressure)
