Carpal Tunnel Syndrome

Question 1

Carpal tunnel syndrome is caused by entrapment of which nerve?

Answer 1

median

Question 2

The median nerve becomes entrapped between what?

Answer 2

The carpal ligament and other structures within the carpal tunnel

Question 3

The contents of the tunnel can be compressed by what type of things?

Answer 3

• synovitis of the tendon sheaths or carpal joints
• recent or malhealed fractures
• tumors
• tissue inflammation
• congenital syndromes

Question 4

In what type of patients is carpal tunnel common?

Answer 4

• pregnant women due to fluid retention
• individuals with a history of repetitive hand use
• in individuals following wrist injury

Question 5

Carpal tunnel syndrome can also be a feature of many systemic diseases such as what?

Answer 5

• RA
• myxedema
• amyloidosis
• sarcoidosis
• leukemia
• acromegaly
• hyperparathyroidism

Question 6

What are the initial signs and symptoms of carpal tunnel syndrome?

Answer 6

Pain, burning, and tingling in the distribution of the median nerve (the palmar surfaces of the thumb, the index and long fingers)

Question 7

What is pain exacerbated by?

Answer 7

manual activity, particularly by extremes of volar flexion or dorsiflexion of the wrist

Question 8

What time of day is carpal tunnel syndrome most bothersome?

Answer 8

at night

Question 9

What sign is usually found positive in carpal tunnel syndrome patients?

Answer 9

Tinel of Phalen sign

Question 10

What is Tinel sign?

Answer 10

tingling or shock-like pain on volar wrist percussion

Question 11

What is Phalen sign?

Answer 11

pain or paresthesia in the distribution of the median nerve when the patient flexes both wrists to 90 degrees for 60 seconds

Question 12

What other test can be performed in order to diagnose carpal tunnel syndrome?

Answer 12

The carpal tunnel compression test, in which direct application of pressure over the carpal tunnel elicits numbness and tingling

Question 13

What are some signs that appear later than sensory disturbances as compression of the nerve worsens?

Answer 13

muscle weakness or atrophy, especially of the thenar eminence

Question 14

What imaging modality can demonstrate flattening of the median nerve beneath the flexor retinaculum?

Answer 14

ultrasound

Question 15

What is the sensitivity of unltrasound for carpal tunnel?

Answer 15

54-98%

Question 16

What special tests can show evidence of sensory conduction delay before motor delay?

Answer 16

electromyography and nerve conduction studies

Question 17

When left-sided what can carpal tunnel be confused with?

Answer 17

angina pectoris

Question 18

What is carpal tunnel syndrome treatment directed towards?

Answer 18

relief of pressure on the median nerve

Question 19

Patients in which carpal tunnel is suspected should have the affected wrist splinted in the neutral position for how long?

Answer 19

3 months

Question 20

When can a patients undergo carpal tunnel release surgery?

Answer 20

When they have had a positive electrodiagnostic test, at least moderate symptoms, high clinical probability, unsuccessful nonoperative treatment, and symptoms lasting longer than 12 months

Question 21

When should you refer a patient?

Answer 21

• if symptoms persist greater than 3 months despite conservative treatment, including the use of wrist splints
• if thenar muscle weakness or atrophy appears