CARPAL TUNNEL SYNDROME
DEFINITION
CARPAL TUNNEL SYNDROME is a syndrome due to compression of the median nerve in the carpal tunnel.
CAUSES
1. Pregnancy.
2. Menopause.
3. Ganglion.
4. Tuberculosis.
5. Diabetes mellitus.
6. Acromegaly.
7. Myxoedema.
8. Injury.
9. Amyloidosis
10. Carcinomatosis.
12. Gout.
13. Idiopathic.
CLINICAL FEATURES
Age Middle aged.
Sex: Common in females.
At first, there may be intermittent tingling and numbness of fingers of one hand particularly at night awakening the patient from bed. Gradually symptoms will appear even during day time. Tingling and numbness are very much prominent in the middle and ring fingers. The pain is relieved by placing the hand in cold water. At the peak of pain, patient characteristically shakes the wrist to get relief. Palmer flexion of the wrist maximum for one minute will induce similar pain (Phale’s test). Tapping over the carpal tunnel will also produce similar pain (Tinel’s sign). Gradually there will be pain in the hand, elbow or even in the shoulder. This is aggravated particularly after use of the hands as in washing, moping, etc. Wasting and weakness of abductor pollicis brevis and opponens pollicis may give rise to hollowing of the thenar eminence. Sensory loss is restricted to palm and radial three and half fingers. EMG is of diagnostic value in doubtful cases.
TREATMENT OF CARPAL TUNNEL SYNDROME
Rest is advisable, Splinting the wrist in the position of slight dorsiflexion may be done. Injection of steroids at the wrist may be of value. Diuretics may help. Surgical division of transverse carpal ligament may be done. Treatment of underlying cause should be done as well.