Carpal Tunnel Syndrome, A Simple Guide To The Condition, Treatment And Related Conditions

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 occurs as a result of pressure on the median nerve between the transverse carpal ligament and the flexor tendons with their inflamed and enlarged synovium.
Local causes:
1. Trauma including injury, fractures
2. Tenosynovitis (inflammation of the tendon and their synovial sheath)
3. Lipoma
4. Ganglion
Systemic causes:
1. Polyarthritis
2. Myxedema (hypothyroidism)
Symptoms:
The onset is usually spontaneous with gradual increasing night pains which cause 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. Paresthesia 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
1. Physical examination
a. 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 occur in median nerve distribution
b. 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 occur in median nerve distribution
c. 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 is by:
1. Treat underlying conditions such as myxedema, polyarthritis, and amyloid
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)
Surgical decompression is by division of the transverse carpal ligament.
Results are usually good.

TABLE OF CONTENT
Introduction
Chapter 1 Carpal Tunnel Syndrome
Chapter 2 More Facts of Carpal Tunnel Syndrome
Chapter 3 Treatment of Carpal Tunnel Syndrome
Chapter 4 Trigger Finger
Chapter 5 De Quervain Disease
Chapter 6 Cervical Spondylosis
Chapter 7 Ganglion
Epilogue