Carpal Tunnel Syndrome: Basics

 ' ENTRAPMENT '

Think: Carpal Tunnel Syndrome (CTS) is the most common 'ENTRAPMENT' neuropathy in rheumatology clinic.

• Entrapment neuropathy, Endocrine diseases (Diabetes, Myxedema & Acromegaly as the aetiology)
• Nocturnal pain and paraesthesia of hand
• Thenar wasting, Thumb abduction weak, Trauma of the wrist/overuse (aetiology)
• Rhematoid arthritis and OA of wrist (aetiology), Relief  of symptoms with steroid injection.
• Abductor pollicis brevis evidently weak, Amyloidosis (occasionally histology of the contents of carpal tunnel useful for confirmation)
• Phalen's sign (maneuver) positive; Pregnancy, oral contraceptive Pills (aetiology)
• Mononeuritis in systemic vasculitis and Leprosy (aetiology)
• Electrophysiological confirmation (many surgeons require) before carpal tunnel decompression
• Night time splintage useful in mild cases
• Tinel's sign positive

Did you know?

Phalen's and Tinel's sign, both are considered as eponymous but unreliable.

There may be a family history of CTS due to small carpal tunnel that runs in families.

There should be a very low threshold for thyroid function test in CTS.