– Carpal tunnel is a over crowded fibro-osseous canal formed by the 3 carpal bones like scaphoid , trapezoid , hamate and transverse carpal ligament.

– Synovitis of tendon can put pressure on the nerve.

– It is a condition in which the median nerve gets compressed as it passes beneath the flexor retinaculum.


• Causes Of carpal tunnel syndrome


– Inflammatory : Rheumatoid arthritis

– Metabolic causes : gout

– Endocrine : hypothyroidism , diabetes mellitus , pregnancy , menopause etc

– malunion of colles fracture

– Gaglion in carpal region

– OA of carpal bones


Clinical features of carpal tunnel syndrome


– Stage 1 : Pain , discomfort in hand but is not localized to median nerve, history  of morning stiffness is present in hand.

– Stage 2 : Tingling and numbness , pain and parasthesia etc. are localized to the area supplied by median nerve.

– Stage 3 : Hand clumsiness and digital function impairment.

– Stage 4 : Sensory loss in median nerve distribution along with wasting of Thenar eminence.

– Burning, aching and warmth.

– Vasomotor symptoms like cold , dry, and shiny skin

– Battle sign : Thumb and index finger contact is poor.

– loss of true opposition.


• Clinical test


(1) Phalen’s test


– Holding a wrist in flexion against each other

– Appearance of symptoms within 1 min of hold indicates Positive sign.


(2) Modified Phalen’s test


(3) Reverse Phalen’s test

– Wrist is held in extension against each other

– Appearance of sensory symptoms within one min indicates Positive sign


(4) Torniquet sign

– Arm cuff of BP instrument is inflated beyond the level of systolic blood pressure of an individual

– If there is appearence of symptoms in median nerve distribution indicates Positive sign.

(5) Bilateral arm percussion test


(6) Vibratory test


(7) Two point discrimination test


• Treatment


(1) Conservative

– Initial stage , NSAID’s is given.

– Carpal tunnel splints  is used.

– Pain free relaxed passive movements or speedy active movements can be given

– Cryotherapy, TENS , Ultrasound over the palmar aspect of wrist is given.

(2) Injection treatment


– Indicated for patients with intermittent symptoms , complaint duration less than 1 year  and if there is no sensory deficits.

– Single infusion of cortisone and the splints for 3 weeks .


(3) Surgery


– Division of flexor retinaculum and transverse carpal ligaments if the conservative treatment fails, any Thenar atrophy, and sensory loss.





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