Table of Contents
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
