Signs ad Symptoms Carp

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Carpal tunnel syndrome

From Wikipedia, the free encyclopedia

Jump to: navigation, search This article is about the medical condition. For the anatomical structure, see Carpal tunnel . For

the Fall Out Boy song, see The Carpal Tunnel of Love. For the Kid Koala album, see Carpal

Tunnel Syndrome album!.

Carpal tunnel syndrome

Transverse section at the wrist. The median nerve is colored

yellow. The carpal tunnel consists of the bones and flexor

retinaculum.

Classification and external resources

ICD-10 !".#

ICD-9 $!%.#

OMIM &&!%$#

DiseasesDB '&!"

MedlinePlus ###%$$

eMedicine orthoped(%!! pmr('& emerg()$ radio(&$!

MeSH *##'$%+

http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#mw-headhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#mw-headhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#p-searchhttp://en.wikipedia.org/wiki/Carpal_tunnelhttp://en.wikipedia.org/wiki/Carpal_tunnelhttp://en.wikipedia.org/wiki/The_Carpal_Tunnel_of_Lovehttp://en.wikipedia.org/wiki/Carpal_Tunnel_Syndrome_(album)http://en.wikipedia.org/wiki/Carpal_Tunnel_Syndrome_(album)http://en.wikipedia.org/wiki/Carpal_Tunnel_Syndrome_(album)http://en.wikipedia.org/wiki/Median_nervehttp://en.wikipedia.org/wiki/Flexor_retinaculum_of_the_handhttp://en.wikipedia.org/wiki/Flexor_retinaculum_of_the_handhttp://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problemshttp://en.wikipedia.org/wiki/ICD-10http://apps.who.int/classifications/icd10/browse/2015/en#/G56.0http://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problemshttp://en.wikipedia.org/wiki/List_of_ICD-9_codeshttp://www.icd9data.com/getICD9Code.ashx?icd9=354.0http://en.wikipedia.org/wiki/OMIMhttp://omim.org/entry/115430http://en.wikipedia.org/wiki/Diseases_Databasehttp://www.diseasesdatabase.com/ddb2156.htmhttp://en.wikipedia.org/wiki/MedlinePlushttp://www.nlm.nih.gov/medlineplus/ency/article/000433.htmhttp://en.wikipedia.org/wiki/EMedicinehttp://www.emedicine.com/orthoped/topic455.htmhttp://www.emedicine.com/orthoped/topic455.htmhttp://www.emedicine.com/pmr/topic21.htmhttp://www.emedicine.com/pmr/topic21.htmhttp://www.emedicine.com/emerg/topic83.htmhttp://www.emedicine.com/emerg/topic83.htmhttp://www.emedicine.com/radio/topic135.htmhttp://en.wikipedia.org/wiki/Medical_Subject_Headingshttp://www.nlm.nih.gov/cgi/mesh/2015/MB_cgi?field=uid&term=D002349http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#p-searchhttp://en.wikipedia.org/wiki/Carpal_tunnelhttp://en.wikipedia.org/wiki/The_Carpal_Tunnel_of_Lovehttp://en.wikipedia.org/wiki/Carpal_Tunnel_Syndrome_(album)http://en.wikipedia.org/wiki/Carpal_Tunnel_Syndrome_(album)http://en.wikipedia.org/wiki/Median_nervehttp://en.wikipedia.org/wiki/Flexor_retinaculum_of_the_handhttp://en.wikipedia.org/wiki/Flexor_retinaculum_of_the_handhttp://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problemshttp://en.wikipedia.org/wiki/ICD-10http://apps.who.int/classifications/icd10/browse/2015/en#/G56.0http://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problemshttp://en.wikipedia.org/wiki/List_of_ICD-9_codeshttp://www.icd9data.com/getICD9Code.ashx?icd9=354.0http://en.wikipedia.org/wiki/OMIMhttp://omim.org/entry/115430http://en.wikipedia.org/wiki/Diseases_Databasehttp://www.diseasesdatabase.com/ddb2156.htmhttp://en.wikipedia.org/wiki/MedlinePlushttp://www.nlm.nih.gov/medlineplus/ency/article/000433.htmhttp://en.wikipedia.org/wiki/EMedicinehttp://www.emedicine.com/orthoped/topic455.htmhttp://www.emedicine.com/pmr/topic21.htmhttp://www.emedicine.com/emerg/topic83.htmhttp://www.emedicine.com/radio/topic135.htmhttp://en.wikipedia.org/wiki/Medical_Subject_Headingshttp://www.nlm.nih.gov/cgi/mesh/2015/MB_cgi?field=uid&term=D002349http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#mw-head


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Carpal tunnel syndrome CS- is a median entrapment neuropathy that causes paresthesia,

pain, numbness, and other symptoms in the distribution of the median nerve due to its

compression at the wrist in the carpal tunnel. The mechanism is not completely understood butcan be considered compression of the median nerve traveling through the carpal tunnel.&/ 0t

appears to be caused by a combination of genetic and environmental factors.'/ 1ome of the

predisposing factors include: diabetes, obesity, pregnancy, hypothyroidism, and heavy manualwork or work with vibrating tools. There is, however, little clinical data to prove that lighter,

repetitive tasks can cause carpal tunnel syndrome. 2ther disorders such as bursitis and tendinitis

have been associated with repeated motions performed in the course of normal work or otheractivities.$/

The main symptom of 3T1 is intermittent numbness of the thumb, index, long and radial half of

the ring finger.%/ The numbness often occurs at night, with the hypothesis that the wrists are held

flexed during sleep. 4ecent literature suggests that sleep positioning, such as sleeping on one5sside, might be an associated factor .!/ 0t can be relieved by wearing a wrist splint that prevents

flexion."/ 6ong7standing 3T1 leads to permanent nerve damage with constant numbness, atrophy

of some of the muscles of the thenar eminence, and weakness of palmar abduction seecarpometacarpal 8oint 9 ovements-.;/


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Some suggest that median nere symptoms can arise rom compression at the leel

o the thoracic outlet or the area where the median nere passes between the two

heads o the pronator teres in the orearm,[$$] but this is debatable! This line o

thin(ing is an attempt to explain pain and other symptoms not characteristic o

carpal tunnel syndrome![$)] Carpal tunnel syndrome is a common diagnosis with an

ob*ectie, reliable, erifable pathophysiology, whereas thoracic outlet syndromeand pronator syndrome are defned by a lac( o erifable pathophysiology and are

usually applied in the context o nonspecifc upper extremity pain!

+umbness and paresthesias in the median nere distribution are the hallmar(

neuropathic symptoms &+S' o carpal tunnel entrapment syndrome! ea(ness and

atrophy o the thenar muscles may occur i the condition remains untreated![$-]

Causes[edit]

Carpal Tunnel Syndrome

.ost cases o CTS are o un(nown causes, or idiopathic![$/] Carpal tunnel syndrome

can be associated with any condition that causes pressure on the median nere at

the wrist! Some common conditions that can lead to CTS include obesity, oral

contracepties, hypothyroidism, arthritis, diabetes, prediabetes &impaired glucose

tolerance', and trauma![$0] Carpal tunnel is also a eature o a orm o Charcot#

.arie#Tooth syndrome type $ called hereditary neuropathy with liability to pressure

palsies!

1ther causes o this condition include intrinsic actors that exert pressure within the

tunnel, and extrinsic actors &pressure exerted rom outside the tunnel', whichinclude benign tumors such as lipomas, ganglion, and ascular malormation![$2]

Carpal tunnel syndrome oten is a symptom o transthyretin amyloidosis#associated

polyneuropathy and prior carpal tunnel syndrome surgery is ery common in

indiiduals who later present with transthyretin amyloid#associated cardiomyopathy,

suggesting that transthyretin amyloid deposition may cause carpal tunnel

syndrome![$3][$4][$5][)%][)$][))][)-]

http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-11http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-CTS_2009-12http://en.wikipedia.org/wiki/Atrophyhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Lazaro_1997-13http://en.wikipedia.org/w/index.php?title=Carpal_tunnel_syndrome&action=edit&section=2http://en.wikipedia.org/wiki/Idiopathichttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-BOOSternbach_1999-14http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Katz_2002-15http://en.wikipedia.org/wiki/Charcot-Marie-Tooth_syndromehttp://en.wikipedia.org/wiki/Charcot-Marie-Tooth_syndromehttp://en.wikipedia.org/wiki/Lipomashttp://en.wikipedia.org/wiki/Ganglionhttp://en.wikipedia.org/wiki/Vascular_malformationhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Tiong_2005-16http://en.wikipedia.org/wiki/Polyneuropathyhttp://en.wikipedia.org/wiki/Cardiomyopathyhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-17http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-18http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-19http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-20http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-21http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-22http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-23http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-11http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-CTS_2009-12http://en.wikipedia.org/wiki/Atrophyhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Lazaro_1997-13http://en.wikipedia.org/w/index.php?title=Carpal_tunnel_syndrome&action=edit&section=2http://en.wikipedia.org/wiki/Idiopathichttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-BOOSternbach_1999-14http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Katz_2002-15http://en.wikipedia.org/wiki/Charcot-Marie-Tooth_syndromehttp://en.wikipedia.org/wiki/Charcot-Marie-Tooth_syndromehttp://en.wikipedia.org/wiki/Lipomashttp://en.wikipedia.org/wiki/Ganglionhttp://en.wikipedia.org/wiki/Vascular_malformationhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Tiong_2005-16http://en.wikipedia.org/wiki/Polyneuropathyhttp://en.wikipedia.org/wiki/Cardiomyopathyhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-17http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-18http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-19http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-20http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-21http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-22http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-23


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The median nere can usually moe up to 5!2 mm to allow the wrist to 6ex, and to a

lesser extent during extension![)/] "ong#term compression o the median nere can

inhibit nere gliding, which may lead to in*ury and scarring! hen scarring occurs,

the nere will adhere to the tissue around it and become loc(ed into a fxed

position, so that less moement is apparent![)0]

+ormal pressure o the carpal tunnel has been defned as a range o )7$% mm, and

wrist 6exion increases this pressure 4#old, while extension increases it $%#old![)/]

8epetitie 6exion and extension in the wrist signifcantly increase the 6uid pressure

in the tunnel through thic(ening o the synoial tissue that lines the tendons within

the carpal tunnel![)2]

or( related[edit]

The international debate regarding the relationship between CTS and repetitie

motion in wor( is ongoing! The 1ccupational Saety and 9ealth :dministration

&1S9:' has adopted rules and regulations regarding cumulatie trauma disorders!

1ccupational ris( actors o repetitie tas(s, orce, posture, and ibration hae been

cited! The relationship between wor( and CTS is controersial; in many locations,

wor(ers diagnosed with carpal tunnel syndrome are entitled to time o< and

compensation![)3][)4]

Some speculate that carpal tunnel syndrome is proo(ed by repetitie moement

and manipulating actiities and that the exposure can be cumulatie! =t has also

been stated that symptoms are commonly exacerbated by orceul and repetitie

use o the hand and wrists in industrial occupations,[)5] but it is unclear as to

whether this reers to pain &which may not be due to carpal tunnel syndrome' or the

more typical numbness symptoms![-%]

: reiew o aailable scientifc data by the +ational =nstitute or 1ccupational Saety

and 9ealth &+=1S9' indicated that *ob tas(s that inole highly repetitie manual

acts or specifc wrist postures were associated with incidents o CTS, but causation

was not established, and the distinction rom wor(#related arm pains that are not

carpal tunnel syndrome was not clear! =t has been proposed that repetitie use o

the arm can a- o the 0 million carpal tunnelcases in the US that year were related to wor(![-)] omen hae more wor(#related

carpal tunnel syndrome than men![--]

Speculation that CTS is wor(#related is based on claims such as CTS being ound

mostly in the wor(ing adult population, though eidence is lac(ing or this! ?or

instance, in one recent representatie series o a consecutie experience, most

patients were older and not wor(ing![-/] @ased on the claimed increased incidence

http://en.wikipedia.org/wiki/Median_nervehttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Ibrahim-24http://en.wikipedia.org/wiki/Median_nervehttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-25http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Ibrahim-24http://en.wikipedia.org/wiki/Synovialhttp://en.wikipedia.org/wiki/Carpal_tunnelhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-26http://en.wikipedia.org/w/index.php?title=Carpal_tunnel_syndrome&action=edit&section=3http://en.wikipedia.org/wiki/Occupational_Safety_and_Health_Administrationhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Derebery_2006-27http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-NINDS_2009-28http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Werner_2006-29http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Graham_2587.E2.80.932593-30http://en.wikipedia.org/wiki/National_Institute_for_Occupational_Safety_and_Healthhttp://en.wikipedia.org/wiki/National_Institute_for_Occupational_Safety_and_Healthhttp://en.wikipedia.org/wiki/Biomechanicshttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Cole_2006-31http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-32http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-33http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-34http://en.wikipedia.org/wiki/Median_nervehttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Ibrahim-24http://en.wikipedia.org/wiki/Median_nervehttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-25http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Ibrahim-24http://en.wikipedia.org/wiki/Synovialhttp://en.wikipedia.org/wiki/Carpal_tunnelhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-26http://en.wikipedia.org/w/index.php?title=Carpal_tunnel_syndrome&action=edit&section=3http://en.wikipedia.org/wiki/Occupational_Safety_and_Health_Administrationhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Derebery_2006-27http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-NINDS_2009-28http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Werner_2006-29http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Graham_2587.E2.80.932593-30http://en.wikipedia.org/wiki/National_Institute_for_Occupational_Safety_and_Healthhttp://en.wikipedia.org/wiki/National_Institute_for_Occupational_Safety_and_Healthhttp://en.wikipedia.org/wiki/Biomechanicshttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Cole_2006-31http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-32http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-33http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-34


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in the wor(place, arm use is implicated, but the weight o eidence suggests that

this is an inherent, genetic, slowly but ineitably progressie idiopathic peripheral

mononeuropathy![-0]

:ssociated conditions[edit]

: ariety o patient actors can lead to CTS, including heredity, siAe o the carpal

tunnel, associated local and systematic diseases, and certain habits![$] +on#

traumatic causes generally happen oer a period o time, and are not triggered by

one certain eent! .any o these actors are maniestations o physiologic aging!

[-2]

Bxamples include

8heumatoid arthritis and other diseases that cause in6ammation o the 6exor

tendons!

ith hypothyroidism, generaliAed myxedema causes deposition omucopolysaccharides within both the perineurium o the median nere, as well as

the tendons passing through the carpal tunnel!

During pregnancy women experience CTS due to hormonal changes &high

progesterone leels' and water retention &which swells the synoium', which are

common during pregnancy!

Preious in*uries including ractures o the wrist!

.edical disorders that lead to 6uid retention or are associated with in6ammation

such as in6ammatory arthritis, CollesE racture, amyloidosis, hypothyroidism,diabetes mellitus, acromegaly, and use o corticosteroids and estrogens!

Carpal tunnel syndrome is also associated with repetitie actiities o the hand and

wrist, in particular with a combination o orceul and repetitie actiities[$0]

:cromegaly causes excessie growth hormones! This causes the sot tissues and

bones around the carpel tunnel to grow and compress the median nere! [-3]

Tumors &usually benign', such as a ganglion or a lipoma, can protrude into the

carpal tunnel, reducing the amount o space! This is exceedingly rare &less than

$F'!

1besity also increases the ris( o CTS indiiduals classifed as obese &@.= G )5' are

)!0 times more li(ely than slender indiiduals &@.= H )%' to be diagnosed with CTS!

[-4]

Double#crush syndrome is a debated hypothesis that compression or irritation o

nere branches contributing to the median nere in the nec(, or anywhere aboe

http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-35http://en.wikipedia.org/w/index.php?title=Carpal_tunnel_syndrome&action=edit&section=4http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-uptodate.com-1http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Stevens_1992-36http://en.wikipedia.org/wiki/Hypothyroidismhttp://en.wikipedia.org/wiki/Myxedemahttp://en.wikipedia.org/wiki/Mucopolysaccharideshttp://en.wikipedia.org/wiki/Synoviumhttp://en.wikipedia.org/wiki/Amyloidosishttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Katz_2002-15http://en.wikipedia.org/wiki/Acromegalyhttp://en.wikipedia.org/wiki/Growth_hormonehttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-37http://en.wikipedia.org/wiki/Tumorhttp://en.wikipedia.org/wiki/Ganglionhttp://en.wikipedia.org/wiki/Lipomahttp://en.wikipedia.org/wiki/Obesityhttp://en.wikipedia.org/wiki/Body_mass_indexhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Werner_1994-38http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-35http://en.wikipedia.org/w/index.php?title=Carpal_tunnel_syndrome&action=edit&section=4http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-uptodate.com-1http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Stevens_1992-36http://en.wikipedia.org/wiki/Hypothyroidismhttp://en.wikipedia.org/wiki/Myxedemahttp://en.wikipedia.org/wiki/Mucopolysaccharideshttp://en.wikipedia.org/wiki/Synoviumhttp://en.wikipedia.org/wiki/Amyloidosishttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Katz_2002-15http://en.wikipedia.org/wiki/Acromegalyhttp://en.wikipedia.org/wiki/Growth_hormonehttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-37http://en.wikipedia.org/wiki/Tumorhttp://en.wikipedia.org/wiki/Ganglionhttp://en.wikipedia.org/wiki/Lipomahttp://en.wikipedia.org/wiki/Obesityhttp://en.wikipedia.org/wiki/Body_mass_indexhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Werner_1994-38


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the wrist, increases sensitiity o the nere to compression in the wrist! There is

little eidence, howeer, that this syndrome really exists![-5]

9eteroAygous mutations in the gene S9-TC), associated with Charcot#.arie#Tooth,

coner susceptibility to neuropathy, including the carpal tunnel syndrome![/%]

Diagnosis[edit]

There is no consensus reerence standard or the diagnosis o carpal tunnel

syndrome! : combination o described symptoms, clinical fndings, and

electrophysiological testing is used by a ma*ority o hand surgeons! +umbness in

the distribution o the median nere, nocturnal symptoms, thenar muscle

wea(ness>atrophy, positie TinelEs sign at the carpal tunnel, and abnormal sensory

testing such as two#point discrimination hae been standardiAed as clinical

diagnostic criteria by consensus panels o experts![/$][/)] : predominance o pain

rather than numbness is unli(ely to be caused by carpal tunnel syndrome no matter

what the result o electrophysiological testing!

Blectrodiagnostic testing &electromyography and nere conduction elocity' can

ob*ectiely eriy the median nere dysunction! +ormal nere conduction studies,

howeer, do not exclude the diagnosis o CTS waiting or nere tests to become

positie may well pre*udice the eentual duration and completeness o recoery,

particularly o the thenar motor branch is inoled!

Clinical assessment by history ta(ing and physical examination can support a

diagnosis o CTS!

PhalenEs maneuer is perormed by 6exing the wrist gently as ar as possible, then

holding this position and awaiting symptoms![/-] : positie test is one that results

in numbness in the median nere distribution when holding the wrist in acute

6exion position within 2% seconds! The Iuic(er the numbness starts, the more

adanced the condition! PhalenEs sign is defned as pain and>or paresthesias in the

median#innerated fngers with one minute o wrist 6exion! 1nly this test has been

shown to correlate with CTS seerity when studied prospectiely![$]

TinelEs sign, a classic J though less sensitie # test is a way to detect irritated

neres! TinelEs is perormed by lightly tapping the s(in oer the 6exor retinaculum to

elicit a sensation o tingling or Kpins and needlesK in the nere distribution! TinelEs

sign &pain and>or paresthesias o the median#innerated fngers with percussion

oer the median nere' is less sensitie, but slightly more specifc than PhalenEs

sign![$]

Dur(an test, carpal compression test, or applying frm pressure to the palm oer the

nere or up to -% seconds to elicit symptoms has also been proposed![//][/0]

9and eleation test The hand eleation test has higher sensitiity and specifcity

than TinelEs test, PhalenEs test, and carpal compression test! Chi#sIuare statistical

http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Wilbourn_1997-39http://en.wikipedia.org/wiki/SH3TC2http://en.wikipedia.org/wiki/Charcot-Marie-Toothhttp://en.wikipedia.org/wiki/Neuropathyhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-40http://en.wikipedia.org/w/index.php?title=Carpal_tunnel_syndrome&action=edit&section=5http://en.wikipedia.org/wiki/Electrophysiologicalhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-41http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Graham_consensus-42http://en.wikipedia.org/wiki/Phalen's_maneuverhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Harrison-43http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-uptodate.com-1http://en.wikipedia.org/wiki/Tinel's_signhttp://en.wikipedia.org/wiki/Flexor_retinaculum_of_the_handhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-uptodate.com-1http://en.wikipedia.org/wiki/Durkan_testhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Gonzalez_1997-44http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Durkan_1991-45http://en.wikipedia.org/w/index.php?title=Hand_elevation_test&action=edit&redlink=1http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Wilbourn_1997-39http://en.wikipedia.org/wiki/SH3TC2http://en.wikipedia.org/wiki/Charcot-Marie-Toothhttp://en.wikipedia.org/wiki/Neuropathyhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-40http://en.wikipedia.org/w/index.php?title=Carpal_tunnel_syndrome&action=edit&section=5http://en.wikipedia.org/wiki/Electrophysiologicalhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-41http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Graham_consensus-42http://en.wikipedia.org/wiki/Phalen's_maneuverhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Harrison-43http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-uptodate.com-1http://en.wikipedia.org/wiki/Tinel's_signhttp://en.wikipedia.org/wiki/Flexor_retinaculum_of_the_handhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-uptodate.com-1http://en.wikipedia.org/wiki/Durkan_testhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Gonzalez_1997-44http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Durkan_1991-45http://en.wikipedia.org/w/index.php?title=Hand_elevation_test&action=edit&redlink=1


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analysis confrms the hand eleation test is not ine


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The carpal tunnel is an anatomical compartment located at the base o the palm!

+ine 6exor tendons and the median nere pass through the carpal tunnel that is

surrounded on three sides by the carpal bones that orm an arch! The median nere

proides eeling or sensation to the thumb, index fnger, long fnger, and hal o the

ring fnger! :t the leel o the wrist, the median nere supplies the muscles at the

base o the thumb that allow it to abduct, or moe away rom the fngers, out o theplane o the palm! The carpal tunnel is located at the middle third o the base o the

palm, bounded by the bony prominence o the scaphoid tubercle and trapeAium at

the base o the thumb, and the hamate hoo( that can be palpated along the axis o

the ring fnger! The proximal boundary is the distal wrist s(in crease, and the distal

boundary is approximated by a line (nown as LaplanEs cardinal line![0)] This line

uses surace landmar(s, and is drawn between the apex o the s(in old between

the thumb and index fnger to the palpated hamate hoo(![0-] The median nere

can be compressed by a decrease in the siAe o the canal, an increase in the siAe o

the contents &such as the swelling o lubrication tissue around the 6exor tendons',

or both![0/] Simply 6exing the wrist to 5% degrees will decrease the siAe o the

canal!

Compression o the median nere as it runs deep to the transerse carpal ligament

&TC"' causes atrophy o the thenar eminence, wea(ness o the 6exor pollicis breis,

opponens pollicis, abductor pollicis breis, as well as sensory loss in the digits

supplied by the median nere! The superfcial sensory branch o the median nere,

which proides sensation to the base o the palm, branches proximal to the TC" and

traels superfcial to it! Thus, this branch spared in carpal tunnel syndrome, and

there is no loss o palmar sensation![00]

Preention[edit]

Suggested healthy habits such as aoiding repetitie stress, wor( modifcation

through use o ergonomic eIuipment &wrist rest, mouse pad', ta(ing proper brea(s,

using (eyboard alternaties &digital pen, oice recognition, and dictation', and

employing early treatments such as ta(ing turmeric &anti#in6ammatory', omega#-

atty acids, and @ itamins hae been proposed as methods to help preent carpal

tunnel syndrome! The potential role o @#itamins in preenting or treating carpal

tunnel syndrome has not been proen![02][03] There is little or no data to support

the concept that actiity ad*ustment preents carpal tunnel syndrome![04]

Stretches and isometric exercises will aid in preention or persons at ris(!

Stretching beore the actiity and during brea(s will aid in alleiating tension at the

wrist![05] Place the hand frmly on a 6at surace and gently pressing or a ew

seconds to stretch the wrist and fngers! :n example or an isometric exercise o the

wrist is done by clinching the fst tightly, releasing and anning out fngers![05]

+one o these stretches or exercises should cause pain or discomort!

http://en.wikipedia.org/w/index.php?title=Kaplan%27s_cardinal_line&action=edit&redlink=1http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-52http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-53http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Gelberman_1981-54http://en.wikipedia.org/wiki/Thenar_eminencehttp://en.wikipedia.org/wiki/Flexor_pollicis_brevishttp://en.wikipedia.org/wiki/Opponens_pollicishttp://en.wikipedia.org/wiki/Abductor_pollicis_brevishttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Norvell_2009-55http://en.wikipedia.org/w/index.php?title=Carpal_tunnel_syndrome&action=edit&section=8http://en.wikipedia.org/wiki/Ergonomichttp://en.wiktionary.org/wiki/wrist_resthttp://en.wikipedia.org/wiki/Mouse_padhttp://en.wikipedia.org/wiki/Digital_penhttp://en.wikipedia.org/wiki/Speech_recognitionhttp://en.wikipedia.org/wiki/Omega-3_fatty_acidhttp://en.wikipedia.org/wiki/Omega-3_fatty_acidhttp://en.wikipedia.org/wiki/B_vitaminhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-56http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-57http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-jhs_lozano-calderon-58http://en.wikipedia.org/wiki/Isometric_exercisehttp://en.wikipedia.org/wiki/Wristhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Nadal-59http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Nadal-59http://en.wikipedia.org/w/index.php?title=Kaplan%27s_cardinal_line&action=edit&redlink=1http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-52http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-53http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Gelberman_1981-54http://en.wikipedia.org/wiki/Thenar_eminencehttp://en.wikipedia.org/wiki/Flexor_pollicis_brevishttp://en.wikipedia.org/wiki/Opponens_pollicishttp://en.wikipedia.org/wiki/Abductor_pollicis_brevishttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Norvell_2009-55http://en.wikipedia.org/w/index.php?title=Carpal_tunnel_syndrome&action=edit&section=8http://en.wikipedia.org/wiki/Ergonomichttp://en.wiktionary.org/wiki/wrist_resthttp://en.wikipedia.org/wiki/Mouse_padhttp://en.wikipedia.org/wiki/Digital_penhttp://en.wikipedia.org/wiki/Speech_recognitionhttp://en.wikipedia.org/wiki/Omega-3_fatty_acidhttp://en.wikipedia.org/wiki/Omega-3_fatty_acidhttp://en.wikipedia.org/wiki/B_vitaminhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-56http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-57http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-jhs_lozano-calderon-58http://en.wikipedia.org/wiki/Isometric_exercisehttp://en.wikipedia.org/wiki/Wristhttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Nadal-59http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Nadal-59


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Carpal tunnel preention stretch

@iological actors such as genetic predisposition and anthropometrics had

signifcantly stronger causal association with carpal tunnel syndrome than

occupational>enironmental actors such as repetitie hand use and stressul

manual wor(![04] This suggests that carpal tunnel syndrome might not be

preentable simply by aoiding certain actiities or types o wor(>actiities!

Treatment[edit]

Menerally accepted treatments include physiotherapy, steroids either orally or

in*ected locally, splinting, and surgical release o the transerse carpal ligament![2%] There is no or insuNcient eidence or ultrasound, yoga, lasers, @2, and

exercise therapy![2%]

The :merican :cademy o 1rthopedic Surgeons recommends proceeding

conseratiely with a course o nonsurgical therapies tried beore release surgery is

considered! [2$] Barly surgery with carpal tunnel release is indicated where there is

eidence o median nere deneration or a person elects to proceed directly to

surgical treatment![2$] The treatment should be switched when the current

treatment ails to resole the symptoms within ) to 3 wee(s! 9oweer, these

recommendations hae suNcient eidence or carpal tunnel syndrome when ound

in association with the ollowing conditions diabetes mellitus, coexistent cerical

radiculopathy, hypothyroidism, polyneuropathy, pregnancy, rheumatoid arthritis,

and carpal tunnel syndrome in the wor(place![2$]

Splints[edit]

http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-jhs_lozano-calderon-58http://en.wikipedia.org/w/index.php?title=Carpal_tunnel_syndrome&action=edit&section=9http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Piaz2007-60http://en.wikipedia.org/wiki/Vitamin_B6http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Piaz2007-60http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-aaos2007-61http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-aaos2007-61http://en.wikipedia.org/wiki/Diabetes_mellitushttp://en.wikipedia.org/wiki/Cervical_radiculopathyhttp://en.wikipedia.org/wiki/Cervical_radiculopathyhttp://en.wikipedia.org/wiki/Hypothyroidismhttp://en.wikipedia.org/wiki/Polyneuropathyhttp://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/wiki/Rheumatoid_arthritishttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-aaos2007-61http://en.wikipedia.org/w/index.php?title=Carpal_tunnel_syndrome&action=edit&section=10http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-jhs_lozano-calderon-58http://en.wikipedia.org/w/index.php?title=Carpal_tunnel_syndrome&action=edit&section=9http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Piaz2007-60http://en.wikipedia.org/wiki/Vitamin_B6http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-Piaz2007-60http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-aaos2007-61http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-aaos2007-61http://en.wikipedia.org/wiki/Diabetes_mellitushttp://en.wikipedia.org/wiki/Cervical_radiculopathyhttp://en.wikipedia.org/wiki/Cervical_radiculopathyhttp://en.wikipedia.org/wiki/Hypothyroidismhttp://en.wikipedia.org/wiki/Polyneuropathyhttp://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/wiki/Rheumatoid_arthritishttp://en.wikipedia.org/wiki/Carpal_tunnel_syndrome#cite_note-aaos2007-61http://en.wikipedia.org/w/index.php?title=Carpal_tunnel_syndrome&action=edit&section=10


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: rigid splint can (eep the wrist straight

The importance o wrist braces and splints in the carpal tunnel syndrome therapy is

(nown, but many people are unwilling to use braces! =n $55-, The :merican

:cademy o +eurology recommend a non#inasie treatment or the CTS at the

beginning &except or sensitie or motor defcit or grae report at B.M>B+M' a

therapy using splints was indicated or light and moderate pathology! [2)] Current

recommendations generally donEt suggest immobiliAing braces, but instead actiity

modifcation and non#steroidal anti#in6ammatory drugs as initial therapy, ollowedby more aggressie options or specialist reerral i symptoms do not improe![2-]

[2/]

.any health proessionals suggest that, or the best results, one should wear braces

at night and, i possible, during the actiity primarily causing stress on the wrists!

[20][22]

Corticosteroids[edit]

Corticosteroid in*ections can be e


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8elease o the transerse carpal ligament is (nown as Kcarpal tunnel releaseK

surgery! =t is recommended when there is static &constant, not *ust intermittent'

numbness, muscle wea(ness, or atrophy, and when night#splinting or other

conseratie interentions no longer control intermittent symptoms![24] =n general,

milder cases can be controlled or months to years, but seere cases are

unrelenting symptomatically and are li(ely to result in surgical treatment![25]

Physical therapy[edit]

: recent eidence based guideline produced by the :merican :cademy o

1rthopedic Surgeons assigned arious grades o recommendation to physiotherapy

&also called physical therapy' and other nonsurgical treatments![3%] 1ne o the

primary issues with physiotherapy is that it attempts to reerse &oten' years o

pathology inside the carpal tunnel! Practitioners caution that any physiotherapy

such as myoascial release may ta(e wee(s o persistent application to e


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hile outcomes are generally good, certain actors can contribute to poorer results

that hae little to do with neres, anatomy, or surgery type! 1ne study showed that

mental status parameters or alcohol use yields much poorer oerall results o

treatment![32]

8ecurrence o carpal tunnel syndrome ater successul surgery is rare![33] = aperson has hand pain ater surgery, it is most li(ely not caused by carpal tunnel

syndrome! =t may be the case that the illness o a person with hand pain ater carpal

tunnel release was diagnosed incorrectly, such that the carpal tunnel release has

had no positie e

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