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Carpal Tunnel Syndrome - CLINICAL


  History:

Sometimes, patients complain of an intermittent pins-and-needles sensation in the median nerve distribution of the hand. This kind of sensation is generally worse at night.

  • Common symptoms of carpal tunnel syndrome are most often bilateral, insidious in onset and progressive in nature.
    • With advanced nerve compression, the aching sensation is persistent and static and may radiate to the forearm and elbow.

Physical:

Tapping the volar wrist over the median nerve (Tinel's sign) may produce paresthesias in the median distribution of the hand.

  • Thenar atrophy may be present in advanced cases of carpal tunnel syndrome (CTS).
  • Hyperflexion of the wrist for 60 seconds may also elicit paresthesias (Phalen's sign).

Causes:

  • Activities involving repetitive wrist flexion, such as assembly packing, computer keyboard work, playing a musical instrument and craftwork, can cause inflammation of the flexor tendon sheath.
  • Pregnancy or oral contraceptive-related related edema can cause compression of the median nerve.
  • Trauma of any type, including fractures, can cause edema that can compress the median nerve.
  • Tuberculosis
  • Hemodialysis
  • Hypothyroidism
  • Amyloidosis
  • Acromegaly
  • Rheumatoid arthritis
  • Gout
  • Renal failure, diabetes mellitus and obesity have all been associated with an increased risk of carpal tunnel syndrome.