Carpal Tunnel Syndrome

Question 1

Define

Answer 1

Median nerve entrapment in flexor retinaculum due to increased pressure, leading to ischemia and demyelination

Question 2

Aetiology

Answer 2

Women
Aged over 30
High BMI

Manual work/using hands/repetitive movements
Wheelchair athletics

Congenital carpal tunnel stenosis
Square wrists

Pregnancy
RA
Diabetes
Dialysis (male prevalence, amyloid deposition)

Cigarettes (weak association) 
Thyroid disorders (weak association)

Question 3

Symptoms

Answer 3

Tingling and numbness thumb to half of ring finger
Worse at night, patients wake up shaking their hands
Pain
Inability to grip/clumsiness
Aching wrist

Question 4

Signs

Answer 4

Hypothenar wasting

Tapping makes the pain worse?

Question 5

Epidemiology

Answer 5

Females>males (3:1 ratio)
Aged between 40 and 60
Predominantly white people

Question 6

Investigations

Answer 6

EMG - diagnostic test of choice
Ultrasound - ganglion cysts
MRI - space occupying lesion

Question 7

Numbness is not seen in which region?

Answer 7

Numbness is not seen in the palmar region of the hand even though it is supplied by the median nerve, this is because this area is supplied by the palmar cutaneous branch of the median nerve which runs over the flexor retinaculum.

Question 8

Explain which bedside tests you may do

Answer 8

Tests - ask pt to abduct thumb (90 degrees to hand), if their abductor pollicis brevis (supplied by median) is affected, their abductor pollicis longus will compensate

Reflexes - should be normal, if not suggests radiculopathy

Question 9

Tapping test is called

Answer 9

Farlans and Tinnels

Tapping and reverse prayer?

Question 10

Blood tests

Answer 10

RA
Diabetes
Thyroid