Carpal Tunnel Syndrome

Impingement on the median nerve through the carpal tunnel. The tunnel is 20mm wide and 25mm long with 9 flexor tendons passing through alongside the median nerve.

Causes

• Inflammation of flexor tendons
• Pregnancy
• Fracture
• Hand intensive activities (e.g. cycling)

Symptoms

• Tenderness over palmar aspect distal to wrist
• Tingling in thumb and next 2.5 fingers
• Hypotrophy of thumb muscles
• Pain worse at night

Testing

• Phalens test
• Flex hands back to back and push for 30secs. Look for reproduction of symptoms. Reverse test into extension also.
• Tinels test
• Extend hand and tap between scaphoid and pisiform. Look for reproduction of symptoms. 

Note: a tight pronator teres (for example as found in drummers) may also cause very similar symptoms.

Treatment

• NSAIDs
• Splinting wrist
• Sports massage
• Stretching
• Operate if chronic