Carpal Tunnel Syndrome

ISHIKA FERNANDEZ & JAINIL TRIVEDI, TY BPT

 Content

Introduction
Related anatomy
Epidemiology
Pathophysiology
Etiology
Clinical Features
Diagnosis
Treatment
 Introduction

It is the irritation of median nerve due to excess pressure exerted over it by the
surrounding structures.

Also called as “Median nerve Compression”

It is progressive in nature.
 Anatomy

Median nerve travels deep to the flexor retinaculum with 9 other tendons.
 Epidemiology

About 3-6% of total population suffer from CTS.

Incidence is 1-3 cases for every 1000 subjects every year

Peak age is 45-65 with only 10% cases below the age of 31.

Female to male ratio varies from 3-10:1.

It is mainly an occupational disorder. Majorly affecting writers or people who

work on computers a lot.
 Pathophysiology

The carpel tunnel is a narrow enclosed space with flexor retinaculum on superior
aspect.

Inflammation/Irritation/Injury/Edema

Increase in pressure in the carpel tunnel

Tendons compress the median nerve in the tunnel since there’s no space to expand.
 Etiology

Occupational Causes Non-occupational causes

Repetitive hand motions, Awkward hand positions, Strong Arthritis, Diabetes, Gout, Hypothyroidism, Pregnancy
gripping forces

Mechanical stress on palm, Vibration Tenosynovitis, Wrist fracture/Dislocation, Hereditary

 Clinical Features

Tingling numbness in palm specifically over the first 3 phalanges.

Numbness

Pain

Weakness of muscles

Uncoordinated fine movements of the fingers

 Signs

Hoffmann-Tinel sign:
Gentle tapping over the nerve to elicit a tingling sensation
typically described as “Pins and Needles” by the patient.

Phalen’s Manoeuvre:
Diagnostic test for CTS, done by performing full flexion of
both the wrists against each other as shown in fig. To compress
the median nerve elevating the symptoms indicating CTS.
 Diagnosis

Majorly based on Clinical findings and tests.

X-ray

Nerve conduction test

 Treatment

Non-Surgical:
Wrist splinting
NSAIDs
Corticosteroids

Surgical: Mainly done to release the pressure over the nerve

Endoscopic surgery
Open surgery
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