A Family Doctor's Tale - CARPAL TUNNEL SYNDROME

DOC I HAVE CARPAL TUNNEL SYNDROME

 Carpal tunnel syndrome is a common disease especially with the women partly due to pregnancy. 
In this age of computers, the usage of the wrist on the keyboard means more compression of the carpal tunnel which is at the wrist.

Carpal Tunnel Syndrome is the compression of the median nerve in the carpal tunnel of the wrist.  
The carpal tunnel is a ligamentous sheath which provides protection for the median nerve as it travels across the carpal bone


Carpal Tunnel Syndrome occur as a result of pressure on the median nerve between the tranverse carpal ligament and the flexor tendons with their inflamed and enlarged synovium.


Local causes:

trauma including injury,fractures
tenosynovitis(inflammation of the tendon and their synovial sheath)
lipoma
ganglion


Systemic causes:
 polyarthritis
myxedema (hypothyroidism)
pregnancy( due to fluid retention)
Amyloid disease


The onset is usually spontaneous with gradual increasing night pains which causes the patient to seek treatment:

1.Painful night tingling sensation of the fingers which can extend to the forearm-relieved by hanging the arm down or shaking 

2.Parethesia and numbness of the index, middle and ring finger

3.Fingers feel clumsy

4.thenar muscle wasting and weakness may be present

5.impairment of light touch and pin prick sensation on the 3 
 middle fingers

6.women are more affected than men


1.Physical examination
Phalen's test- flex wrists so that the dorsal surfaces of the hands are in full contact with each other, hold for 1 min: tingling and numbness in median nerve distribution

Reverse Phalen's test(prayer Sign)-extend wrists so that the palms of hands are in full contact like in prayer, hold for 1 min: tingling and numbness in median nerve distribution

Tinel's test - tap volar surface of the wrist:tingling means positive test

2.EMG - electromyography to test movement of the muscles

3.Nerve conduction tests on median nerve


Treatment of carpal tunnel syndrome:
1.Treat underlying conditions such as myxedema(low thyroid hormone), polyarthritis, amyloidosis


2.diuretic in mild cases and those present in pregnant women
NSAIDS may reduce inflammation.

3.wrist splintage in extension


4.injection of the carpal tunnel with corticosteroid (avoiding the carpal nerve)


5.Surgical decompression by division of the transverse carpal ligament.

Results are usually good.