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Carpal tunnel syndrome

Carpal tunnel syndrome is a median nerve entrapment neuropathy caused by compression of the median nerve in the carpal tunnel.

Causes

  • Idiopathic
  • Pregnancy
  • Obesity
  • Rheumatoid arthritis
  • Local extrinsic pressure, e.g. ganglion, lipoma, fracture, haematoma
  • Endocrinological
    • Diabetes
    • Hypothyroidism
    • Acromegaly

Clinical features

  • Intermittent paraesthesia, pain/burning and numbness of thumb, first, middle and radial half of ring finger
  • Loss of strength and wasting of the thenar eminence
  • Symptoms often worse at night
  • Phalen’s test +ve
  • Tinel’s test +ve

Differential diagnosis

  • Thoracic outlet syndrome
  • Pronator teres syndrome (compression of median nerve at elbow)

Management

  • Conservative
    • Watch and wait (spontaneous resolution occurs in 25% over 1 year)
    • Wrist splint (especially at night)
    • Corticosteroid injection
    • NSAIDs may help
  • Surgical carpal tunnel release: transverse carpal ligament over volar aspect of wrist incised under local anaesthesia) – recurrence rare
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