What is Carpal Tunnel Syndrome?

What is involved?

Median Nerve at the wrist

The Carpal Tunnel, at the wrist

Worse in the dominant hand
Dropping objects
Numbness tingling, hand/wrist —-> Thumb, Index and/or Middle finger
May radiate up the arm, occasionally to the shoulder
Symptoms primarily at night. Patient wakes up and shake their hands to obtain relief
Frequently bilateral, although may only be symptomatic on one side

Usually slow, insidious over months/years

Women more than Men, Diabetes or family history, Pregnancy, weight gain, trauma, HIV infection
Working with hands a lot, secretaries, homemakers, operating machinery, computer joysticks, factory workers in assembly jobs, manual laborers

Look for hand Abductor Pollicis Brevis (APB) flattening
Test the APB strength (push thumb upwards against resistance)
Positive Tinel sign (tingling upon tapping nerve) at the wrist usually with appropriate radiation to finger(s) with symptoms

Very good at localizing Median entrapment to the Carpal Tunnel (disease is frequently bilateral, so test other side even if asymptomatic)

Ulnar testing helpful for comparing Median and Ulnar distal latencies, and checking for underlying peripheral neuropathy.

Prolonged Median Sensory/Motor distal latencies
If Median and Ulnar Conductions are abnormal, test the lower extremity to rule out Peripheral Neuropathy
Check for active/Chronic denervation in the APB on Needle Examination

Mild ——> Wrist splints, wear mostly at night

Moderate ——> Wrist splints/Steroid Injection (contraindicated in Diabetics)

Severe or active denervation in APB ——> Surgery

Stop/address cause of problem
Treat Diabetes if present, address weight gain problems
Wrist splints (both sides) mostly at night for mild to moderate carpal tunnel (see above)
Steroid Injections, Surgery for moderate to severe cases (see above)
Surgery may be indicated if mild to moderate but symptoms intolerable or interfere with job

Repetitive stress injury with joint, tendon, myofascial symptoms (not carpal tunnel) in musicians, computer/machinery operators
Cervical root lesion
Thoracic outlet syndrome (very rare)