Carpal Tunnel Syndrome Causes * Compression, Entrapment * Repetitive strain injury * Pregnancy * Depression * Inflammation, swelling * Deposition of cyst fluid * Thickening of tendons * Calcification, gout * Hypothyroidism * Myxedema * Scleroderma, Sjogren's syndrome * Endocrine disorders * Rheumatoid disease * Autoimmune diseases * Pregnancy * Idiopathic * Medial epicondylitis * Metacarpal fractures * Tendonitis * Carpal hypoplasia Symptoms * Numbness, tingling * Pain in thumb, index, middle & ring finger * Loss of thumb side of hand * Weakness * Clumsiness Carpal Tunnel Syndrome Carpal Tunnel Median nerve [Diagram of the carpal tunnel and median nerve] Causes * Compression * Inflammation * Swelling * Thickening of tendons * Cyst fluid buildup * Entrapment Symptoms * Numbness, tingling * Pain in thumb, index, middle & ring finger * Loss of thumb side of hand * Weakness * Clumsiness Carpal Tunnel Syndrome * Paresthesia * Hypoesthesia * Hyperalgesia * Palsy * Burning or tingling sensation * Hand weakness * Loss of fine motor skills * Pain in 1st 3 digits * Unusual sensation * Inability to contract abductor brevis * Interference with signals to brain Carpal Bones * May enlarge due to inflammation * Mechanical disruption of median nerve Carpal Tunnel Syndrome * May occur due to repetitive activities * Sleeping, driving, typing, holding phone or cup * Ability to contract abductor brevis may decrease * Unusual sensation * Interference with signals to brain Median nerve * Travels through carpal tunnel * Passes beneath carpal ligament * Supplies sensation and movement to 1st 3 ½ digits Carpal Tunnel Syndrome * Palmar branch * From median nerve * Supplies sensation of the anterolateral palm Median nerve * Not affected * No loss of sensation of the anterolateral palm Recovery * May occur naturally * May require surgery * Splinting can help Carpal Tunnel Syndrome * Axonotmesis: nerve damage * May lose sensation of the entire palm of hand * Recovery impossible * Axons no longer have an endoneurial tube to guide regrowth Carpal Tunnel Syndrome * Impaired axonal transport * Ischemia * Hypoxia * Due to ischemia * Impaired axonal transport Carpal Tunnel Syndrome * May affect blood supply to median nerve * Ischemia * Hypoxia * Reduced blood flow Carpal Tunnel Syndrome * May result in impaired axonal transport * Ischemia * Hypoxia * Reduced blood flow to median nerve Carpal Tunnel Syndrome * May result in impaired axonal transport * Ischemia * Hypoxia * Reduced blood flow to median nerve Diagnosis * Phalen's test * Tinel's sign * Carpal tunnel syndrome questionnaire * Nerve conduction study Symptoms were * tingling * E numb Followed by mild/moderate/severe loss of sensory amplitude sensory impulse slowing across the wrist Nerve Conduction Study Treatment & Management * Behavioral modification * Typing - hands parallel to each - wrists relaxed - use mouse rather than touchpad - wrist support when typing * Physical therapy * Stretching, isometric exercises Splinting * For more severe cases Surgical division of transverse carpal ligament * Opens carpal tunnel * Relieves pressure on median nerve Diagnosis * Phalen's test * Tinel's sign * Carpal tunnel syndrome questionnaire * Nerve conduction study Symptoms were * tingling * E numb Followed by mild/moderate/severe loss of sensory amplitude sensory impulse slowing across the wrist Nerve Conduction Study Treatment & Management * Behavioral modification * Typing - hands parallel to each - wrists relaxed - use mouse rather than touchpad - wrist support when typing * Physical therapy * Stretching, isometric exercises Splinting * For more severe cases Surgical division of transverse carpal ligament * Opens carpal tunnel * Relieves pressure on median nerve