Carpal Tunnel Syndrome (CTS)
CTS is the most common entrapment neuropathy, caused by compression of the median nerve as it passes through the carpal tunnel under the transverse carpal ligament (flexor retinaculum).
Contents of the Carpal Tunnel:
- 9 Flexor Tendons: 4 Flexor Digitorum Superficialis, 4 Flexor Digitorum Profundus, 1 Flexor Pollicis Longus.
- 1 Nerve: Median Nerve.
| Clinical Test | Method |
|---|---|
| Phalen Test | Ask the patient to hold wrists in acute flexion for 60 seconds; positive if paresthesia in the median nerve distribution occurs. |
| Tinel Sign | Percuss the volar aspect of the wrist over the median nerve; positive if a “tingling” sensation occurs. |
High-Yield Clinical Notes:
- Classic Symptoms: Nocturnal hand pain/numbness, atrophy of the thenar eminence (late sign), and weakness in thumb opposition.
- Associated Conditions: Pregnancy, diabetes, hypothyroidism, rheumatoid arthritis, and acromegaly.
- Treatment: Wrist splinting (often at night), corticosteroid injection, or surgical decompression (transection of the transverse carpal ligament).