Case Of the Week (COW) 27 December 2015
Carpal Tunnel Syndrome
Findings
Bowing of the flexor retinaculum. Enlargement of the median nerve proximal to carpal tunnel. Flattening of the median nerve at the level of the hook of the hamate. Loss of fat and crowding within the carpal tunnel .
Discussion
Carpal tunnel syndrome is the most common peripheral neuropathy of the upper extremity and results from compression of the median nerve beneath the transverse carpal ligament. This syndrome most often affects middle-aged women. Physical examination with percussion may evoke tingling (the Tinel sign) in the median nerve at the wrist. Sensory nerve function may be abnormal and is easily evaluated by testing with a light touch or pin-prick. Results of the Phalen maneuver (extreme flexion of the wrist to test for dysesthesia), Flick test (shaking of the hand to see whether symptoms are relieved), and percussion (for the Tinel sign) are frequently positive in patients with carpal tunnel syndrome. Median nerve conduction testing may reveal a delayed conduction signal at the wrist, and needle-electrode electromyography may help detect denervation in the intrinsic hand muscles. In carpal tunnel syndrome, nerve enlargement is best evaluated at the level of the pisiform bone, where its diameter is 1.6–3.5 times that at the level of the distal radioulnar joint .
Contributed By:
Dr Balaji Ayyamperumal
Tanjavur Medical College
Carpal Tunnel Syndrome
Findings
Bowing of the flexor retinaculum. Enlargement of the median nerve proximal to carpal tunnel. Flattening of the median nerve at the level of the hook of the hamate. Loss of fat and crowding within the carpal tunnel .
Discussion
Carpal tunnel syndrome is the most common peripheral neuropathy of the upper extremity and results from compression of the median nerve beneath the transverse carpal ligament. This syndrome most often affects middle-aged women. Physical examination with percussion may evoke tingling (the Tinel sign) in the median nerve at the wrist. Sensory nerve function may be abnormal and is easily evaluated by testing with a light touch or pin-prick. Results of the Phalen maneuver (extreme flexion of the wrist to test for dysesthesia), Flick test (shaking of the hand to see whether symptoms are relieved), and percussion (for the Tinel sign) are frequently positive in patients with carpal tunnel syndrome. Median nerve conduction testing may reveal a delayed conduction signal at the wrist, and needle-electrode electromyography may help detect denervation in the intrinsic hand muscles. In carpal tunnel syndrome, nerve enlargement is best evaluated at the level of the pisiform bone, where its diameter is 1.6–3.5 times that at the level of the distal radioulnar joint .
Contributed By:
Dr Balaji Ayyamperumal
Tanjavur Medical College