Carpal tunnel syndrome

Carpal tunnel syndrome

• pain/pins and needles in thumb, index, middle finger
• unusually the symptoms may 'ascend' proximally
• patient shakes his hand to obtain relief, classically at night

• weakness of thumb abduction (abductor pollicis brevis)
• wasting of thenar eminence (NOT hypothenar)
• Tinel's sign: tapping causes paraesthesia
• Phalen's sign: flexion of wrist causes symptoms

• idiopathic
• pregnancy
• oedema e.g. heart failure
• lunate fracture
• rheumatoid arthritis
  rheumatoid arthritis
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• motor + sensory: prolongation of the action potential
  motor + sensory: prolongation of the action potential
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• NICE recommends a 6-week trial of conservative treatments
  6-week trial of conservative treatments
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  if the symptoms are mild-moderate
  • corticosteroid injection
  • wrist splints at night: particularly useful if transient factors present e.g. pregnancy
    pregnancy
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• if there are severe symptoms or symptoms persist with conservative management:
  • surgical decompression (flexor retinaculum
    flexor retinaculum
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    division)