Carpal tunnel syndrome is a mononeuropathy caused by compression of the median nerve between the carpal bones and the transverse carpal ligament.
It is the commonest peripheral nerve problem in the UK.
Presentation:
- Paraesthesia/pain in thumb and first 2.5 fingers
- Weakness/clumsiness of the hand
- Symptoms provoked by sleep/sustained hand or arm positions/repetitive actions
- Symptoms relieved by change of position/shaking wrist
Associations:
- Endocrinological – diabetes, hypothyroidism, acromegaly
- Rheumatological - RA, SLE, scleroderma, gout
- Renal – renal failure, long term haemodialysis
- Other – pregnancy, menopause, obesity, alcoholism
Tests/investigations:
- Tinel’s test – tapping over median nerve at wrist provokes symptoms
- Phalen’s test – wrist flexion for one minute induces paresthesia
- Nerve conduction studies – gold standard but generally only used if diagnosis is unclear
- US – rarely used
- BM for diabetes – cheap, simple and usually performed
Management:
- Splinting
- Steroid injections
- Surgical decompression
- ?NSAIDs for pain
- ?diuretics if swelling
References:
