CARPAL TUNNEL SYNDROME

CARPAL TUNNEL SYNDROME

A medical condition in which the median nerve is compressed at the  wrist, leading to pain, paresthesias, and muscle weakness in the forearm and hand. 

* Carpal tunnel syndrome is the most common & widely known entrapment neuropathy in which the body’s peripheral nerve is compressed or traumatized.

* Carpal tunnel syndrome occurs when the median nerve is compressed in the carpal tunnel below flexor retinaculum.

* The carpal tunnel is a narrow rigid passage way of ligament & bones at the base of hand, in front of distal part of wrist.

* Carpal tunnel houses the median nerve & 9 tendons (4 FDS, 4 FDP & FPL).

Associated conditions that can leads to carpal tunnel syndrome are: 

1. Idiopathic (most common)

2. Pregnancy

3. Endocrine disorders

* Hypothyroidism

* Diabetes mellitus

* Myxedema

* Acromegaly

* Hyperparathyroidism

4. Deposition disorders

* Rheumatoid disorder

* Gout

* Rheumatic disorder

* Amyloidosis

* Sarcoidosis

* Leukemia

* Chronic renal failure

CLINICAL FEATURES:

* Symptoms usually start gradually, with frequent burning, tingling, paraesthesia and numbness in the distribution of median nerve, i.e. lateral three & half of fingers and lateral 2/3 rd of palm. 

* Sensory symptoms can often be reproduced by percussing over median nerve (Tinel’s sign) or by holding the wrist fully flexed for a minute (Phalen’s test).

* As a disease progress, clumsiness of hand and impairement of digital function develop.

* Later in the disease, there is sensory loss in median nerve distribution and obvious wasting of thenar eminence.

CLINICAL TEST FOR CARPAL TUNNEL SYNDROME

* There are some provocative tests which act as important screening methods:

1. Wrist flexion (Phalen’s test):

* The patient is asked to actively place the wrist in complete flexion.

* If tingling & numbness develop in the distribution of median nerve, the test is positive.

* This is most sensitive provocative test.

2. Tourniquet test:

* A pneumatic BP cuff is applied proximal to the elbow & inflated higher than the patient’s systolic BP.

* The test is positive if there is paraesthesia or numbness in the region of median nerve distribution in hand.

3 .Median nerve percussion test (Tinel’s sign):

The median nerve is gently tapped at the wrist. The test is positive if there is tingling sensation.

4. Median nerve compression test:

* Direct pressure is exerted equally over both wrists by the examiner.

* If symptoms of carpal tunnel syndrome appear, the test is positive.

NERVE	PLACE	USUALLY REFERRED TO AS
Median	Carpal tunnel	Carpal tunnel syndrome
Median (anterior interosseous)	Proximal forearm	Anterior interosseous syndrome
Median	Pronator teres	Pronator teres syndrome
Median	Ligament of Struthers	Ligament of Struthers syndrome
Ulnar	Cubital tunnel	Cubital tunnel syndrome
Ulnar	Guyon’s canal	Guyon’s canal syndrome
Radial	Axilla	Radial nerve compression
Radial	Spiral groove	Radial nerve compression
Radial (posterior interosseous)	Proximal forearm	Posterior interosseous nerve entrapment
Radial (superficial radial)	Distal forearm	Wartenberg’s Syndrome
Suprascapular	Suprascapular notch	Suprascapular nerve entrapment

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