Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

Compression of the median nerve within the carpal tunnel causing pain, numbness, and weakness in the hand.

What causes carpal tunnel syndrome?

• Repetitive wrist use

• Pregnancy

• Hypothyroidism

• Diabetes

• RA

• Obesity.

What is the pathophysiology of carpal tunnel syndrome?

Increased pressure in carpal tunnel → median nerve compression → sensory and motor deficits.

What symptoms occur in carpal tunnel syndrome?

• Numbness/tingling in thumb, index, middle fingers

• Nocturnal symptoms

• Hand weakness.

What fingers are affected in carpal tunnel syndrome?

Thumb, index, middle, and radial half of ring finger.

What physical exam findings suggest carpal tunnel syndrome?

• Thenar atrophy

• Decreased grip strength

• Sensory loss in median nerve distribution.

What special test is positive in carpal tunnel syndrome?

Phalen’s test.

What does a positive Phalen’s test indicate?

Wrist flexion reproduces median nerve symptoms.

What other special test may be positive?

Tinel’s sign (tapping over median nerve reproduces symptoms).

What test assesses median nerve compression?

Carpal compression test.

What imaging is used for carpal tunnel syndrome?

None required

What diagnostic study confirms carpal tunnel syndrome?

Nerve conduction studies showing slowed median nerve conduction.

What are treatment goals for carpal tunnel syndrome?

• Reduce nerve compression

• Improve symptoms

• Prevent permanent nerve damage.

What is initial treatment for carpal tunnel syndrome?

Nighttime wrist splinting in neutral position.

What medications help manage symptoms?

NSAIDs

What interventional treatment may be used?

Corticosteroid injection into carpal tunnel.

When is surgery indicated for carpal tunnel syndrome?

• Persistent symptoms

• Motor weakness

• Thenar atrophy

• Failed conservative therapy.

What is the surgical treatment?

Carpal tunnel release.

What complications may occur in carpal tunnel syndrome?

• Permanent sensory loss

• Thenar muscle atrophy

• Weak grip strength.

What is the most serious complication?

Permanent median nerve damage.

What follow‑up is required?

Monitor symptoms, strength, and response to splinting or injections.

What conditions mimic carpal tunnel syndrome?

• Cervical radiculopathy (C6)

• Pronator syndrome

• Diabetic neuropathy.

What feature differentiates carpal tunnel from cervical radiculopathy?

Radiculopathy includes forearm pain and symptoms worsened by neck movement.

What feature differentiates carpal tunnel from pronator syndrome?

Pronator syndrome lacks nocturnal symptoms and has forearm tenderness.