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Monday, March 17, 2014

Carpal Tunnel Syndrome







  • The median nerve runs down the palm side of the wrist in a compartment called the carpal tunnel (made of ligaments and other structures).
  • When structures in the carpal tunnel compress (push against) the median nerve, it causes pain and other symptoms.  This is known as carpal tunnel syndrome.  The most common cause is repetitive hand movement, such as working at a computer keyboard.

  • Pain/burning in wrist or hand
  • Pain may radiate to forearm or shoulder
  • Activity with hand or wrist makes pain worse

  • Synovitis (inflammation of tendons or ligaments of the carpal tunnel) is usually due to repetitive motion of fingers, hands, or wrist.  This is the most common cause.
  • Bone fractures
  • Tumors
  • Genetic abnormalities
  • Arthritis
  • Sarcoid
  • Acromegaly
  • Hyperparathyroidism
  • Hypocalcemia
  • Diabetes

  • Examination:
  1. Tinel's sign -- tingling or shock pain when the area below the wrist is tapped
  2. Phalen's sign -- pain or loss of sensation when both wrists are completely bent for 60 seconds
  3. Muscle weakness and/or loss of muscle mass in muscles of hand
  • Tests:
Electromyography (EMG) and nerve conduction test

  • Avoidance of, or rest from, the triggering activity (e.g., typing)
  • Splinting of hand and forearm at night
  • Corticosteroid injections into the carpal tunnel compartment (it decreases inflammation)
  • Surgery
  • Treat underlying cause if one exists (e.g., arthritis, tumor).

  • Herniated disc in neck region
  • Nerve compression in shoulder
  • Mono-neuritis multiplex

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