This document discusses peripheral neuropathy and carpal tunnel syndrome (CTS). CTS is the most common entrapment neuropathy where the median nerve is compressed at the wrist by the transverse carpal ligament. CTS causes pain or paresthesia in the first three digits and radial half of the fourth digit, as well as sensory loss in the median nerve distribution. Other signs include weakness of the thenar muscles and positive Tinel's and Phalen's signs. Treatment options include rest, wrist splints, medications like NSAIDs, and surgery for cases that are unresponsive to conservative measures.

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