This document discusses carpal tunnel syndrome, which is caused by compression of the median nerve as it passes through the carpal tunnel of the wrist. It can cause numbness, tingling, and weakness in the hand. The presentation outlines the causes, clinical features, diagnosis, and treatment options for carpal tunnel syndrome, which include wrist splints, oral anti-inflammatory medications, local steroid injections, and carpal tunnel release surgery if conservative measures fail. The document provides details on physical exam findings and special tests like Tinel's and Phalen's maneuvers used to diagnose carpal tunnel syndrome.

1. Presented by:
Anish Dhakal
24th May, 2019
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2. Introduction
 Also known as nerve compression syndrome
 Compression of peripheral nerve
 When nerve traverse fibro-osseous tunnel, risk of
entrapment and compression
 Nerve compression
 impairs epineural blood flow and axonal conduction 
giving rise to symptoms

3. Introduction
 Symptoms
 Numbness
 Paraesthesia
 Muscle weakness
 Prolonged or severe compression
 Segmental demyelination
 Target muscle atrophy
 Nerve fibrosis

4. Entrapment Neuropathies
 Median Neuropathy
 Ulnar Neuropathy
 Radial Neuropathy
 Common peroneal Neuropathy
 Proximal Femoral Neuropathy
 Lateral Femoral Neuropathy
 Posterior tibial neuropathy

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6. Carpal Tunnel Syndrome
 Most common entrapment neuropathy
 Compression of the median nerve at the wrist
 Swelling  Compression  Ischemia of nerve
 More common in women
 Age group: 40–50 years

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8. Causes
Inflammatory causes Rheumatoid arthritis
Wrist osteoarthritis
Post-traumatic causes Bone thickening after a
Colles' fracture
Endocrine causes Diabetes
Myxoedema
Acromegaly
Hypothyroidism
Pregnancy
Idiopathic commonest cause

9. Clinical Features
 Pain and paraesthesia in the distribution of median
nerve in hand
 Burning pain, tingling and numbness causing
patient to wake up at night
 Relieving factor: hanging the arm over the side of
the bed or shaking the arm

10. sensory lossMedian nerve distribution

11. Diagnosis
 History
 Motor examination
 Wasting and weakness of the median- innervated hand
muscles (LOAF muscles)
 L - First and second lumbricals
 O - Opponens pollicis
 A - Abductor pollicis brevis
 F - Flexor pollicis brevis

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13. Special Test
 Tinel’s nerve percussion test
 Gentle tapping over the median nerve in the carpal
tunnel region elicits tingling in the nerve distribution
 Phalen’s wrist flexion test
 Full flexion of the wrists for up to 60 seconds induce
tingling sensation
 Electromyography

14. Tinel’s sign
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15. Phalen’s test
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17. Wrist Splints & Physiotherapy
 Light splints that prevent wrist flexion help those
with night pain or with pregnancy-related symptoms
 Most effective when it is applied within three months
of the onset of symptoms

18. Oral medication
 Nonsteroidal anti-inflammatory drugs (NSAIDs)
 Orally administered corticosteroids
 Prednisolone 20 mg per day for two weeks followed by
10 mg per day for two weeks

19. Failure of conservative therapy:
 Long duration of symptoms (>10 months)
 Age greater than 50
 Constant paresthesias
 Impaired two-point discrimination (>6 mm)
 Positive Phalen's sign <30 seconds
 Prolonged motor and sensory latencies demonstrated by
electrodiagnostic testing

20. Treatment
 Oral glucocorticoid or injections: 10 to 20 mg of
lidocaine without epinephrine + 20 to 40 mg of
methylprednisolone acetate
 Surgical: carpel tunnel release

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22. Local Injection
 Steroid injection into the carpal canal provides
temporary relief
 Splinting is generally recommended after local
corticosteroid injection
 If the first injection is successful, a repeat injection can be
considered after a few months
 Surgery should be considered if a patient needs more
than two injections

23. Surgery
 Partial or complete surgical division of flexor
retinaculum Carpal tunnel release
 If symptoms are refractory to conservative measures or if
nerve conduction studies show severe entrapment
 Relieves both compression and resulting symptoms

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25. References
 Harrison’s Principle of Internal Medicine, 19th edition
 Apley’s System of Orthepedics & Fractures, 9th edition
 Maheshwari J, Essentials orthopedics, 4th edition

26. Thank You