Carpal tunnel syndrome

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. 

  • 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 

  • Endocrinological – diabetes, hypothyroidism, acromegaly 
  • Rheumatological - RA, SLE, scleroderma, gout 
  • Renal – renal failure, long term haemodialysis 
  • Other – pregnancy, menopause, obesity, alcoholism 

  • 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 

  • Splinting 
  • Steroid injections 
  • Surgical decompression 
  • ?NSAIDs for pain 
  • ?diuretics if swelling 

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