Carpal Tunnel Syndrome

Question 1

Contents of the carpal tunnel

Question 2

Causes of carpal tunnel syndrome (remember MEDIAN TRAP)

Answer 2

• M: myxoedema
• E: oedema
• D: diabetes mellitus
• I: idiopathic
• A: acromegaly
• N: neoplasm​
• T: trauma
• R: rheumatoid arthritis
• A: amyloidosis
• P: pregnancy

Question 3

Signs and symptoms of carpal tunnel syndrome

Answer 3

• Key risk factors include age >30 years, female sex and high BMI
• Numbness of the hand
• Worse at night
• Numbness in median nerve distribution (sparing of thenar eminence and other peripheral teritories)
• Intermittent symptoms
• Onset is gradual
• Weakness of the hand
• Climsiness
• Aching pain in arm
• Weakness of thenar muscles (abductor pollicis brevis in particular)
• Normal reflexes
• Tinel’s positive (tapping produces tingling)
• Phalen’t positive (reverse prayer sign produces tingling)

Question 4

Management of carpal tunnel syndrome

Answer 4

• Splinting (neutral or 20^o extension worn every night for a month)
• Steroid injections
• Decompression by surgical release