Carpal Tunnel Syndrome. \features of carpal tunnel syndrome. - sings & examination - treatment

1. Peripheral neuropathy.
Turki M. Alanazi

2. Objectives
• Enumerate sites of peripheral nerve compression and
discuss features of carpal tunnel syndrome.

3. Sites of peripheral nerve compression

4. Carpal Tunnel Syndrome.
• Most common entrapment neuropathy.
• Female to Male ration = 4:1
• Compression of the Median Nerve at the wrist by the
Transverse Carpal Ligament.

5. Carpal Tunnel Syndrome.
• Idiopathic cause but it is associated with ..
▫ Occupation.
▫ Hypothyroidism
▫ Diabetes mellitus
▫ Pregnancy (third trimester)
▫ Obesity.
▫ Rheumatoid disease
▫ Acromegaly
▫ amyloid
▫ Renal dialysis patients.

6. Clinical Features
• Pain or paresthesia (numbness and tingling) in the first
three digits and the radial half of the fourth digit ( 3.5)
 patient awakened at night, the pain is relieved by shaking or
rubbing.
• Sensory loss in median nerve distribution i.e. radial 3.5
digits.
• Weakness and wasting of Thenar muscles ( late
feature).
• Positive Tinel’s sign.
• Positive Phalen’s sign.

8. Tinel’s sign

9. Phalen’s maneuver/sign

11. CTS Treatment
• Most cases of CTS can be adequately treated with
conservative (i.e. non-surgical) management.
▫ Rest
 avoid repetitive wrist and hand motion, wrist splints when
repetitive wrist motion required.
▫ Wrest splint
 night time splinting to keep wrist in neutral position.
▫ Medications
 NSAIDs, local corticosteroids injection, oral
corticosteroids

12. Surgical treatment of CTS
• Indications for surgery:
 Numbness and tingling ± sensory loss.
 Weakness ± muscle atrophy.
 Unresponsive to conservative measures.
Open Endoscopic

13. Summary
• Sites of peripheral
neuropathies
• Pain or paresthesia
(numbness and tingling) in
the first three digits and the
radial half of the fourth digit
( 3.5).
• Sensory loss in median
nerve distribution i.e. radial
3.5 digits.
• Weakness and wasting of
Thenar muscles ( late
feature).
• Positive Tinel’s sign.
Clinical features of CTS

14. References