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Carpal tunnel syndrome is a collection of symptoms and signs caused by…
Carpal tunnel syndrome is a collection of symptoms and signs caused by compression of the median nerve in the carpal tunnel at the wrist.
Assessment
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Examination
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Dry skin on the thumb, index, and middle fingers – trophic ulcers at the tips of the digits may be present.
Positive findings on tests such as Phalen's, Tinel’s and the carpal tunnel compression test.
Phalen’s test is positive if flexing the wrist for 60 seconds causes pain and paraesthesia in the median nerve distribution
Tinel's test is positive if tapping lightly over the median nerve at the wrist produces paraesthesia or pain in the median nerve distribution
carpal tunnel compression test (Durkan’s test) is positive if pressure over the proximal edge of the carpal ligament (proximal wrist crease) with the thumbs produces or worsens paraesthesia in the distribution of the median nerve
Examine the cervical spine and carry out a musculoskeletal and neurological examination of the upper limb.
Symptoms
numbness or altered sensation and burning or pain in the distribution of the median nerve (the thumb, index finger, middle finger, and radial half of the ring finger).
Symptoms can be worse at night, may affect sleep and can affect one or both hands.
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Differentials
radiculopathies (especially C6/7), vibration white finger, OA of metacarpophalangeal joint of the thumb
Cervical radiculopathy; Ulnar nerve compression; De Quervains tenosynovitis; Lateral epicondylitis; Osteoarthritis or inflammatory arthritis; Vibration white finger or hand-arm vibration syndrome; Raynaud’s phenomenon.
Neuropathy due to conditions such as diabetes mellitus, hypothyroidism, and B12 deficiency
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