Carpal Tunnel Syndrome
What is it: The carpal tunnel is on the volar side of the wrist and contains the median nerve along with the flexor digitorum profundus and superficialis tendons and flexor pollicis longus tendon. The median nerve can be compressed as it passes thru this tunnel.
How does it present: Symptoms of carpal tunnel syndrome include wrist pain that can radiate into the hand or up the arm to the shoulder region. Paresthesias or numbness into the thumb, index and middle fingers and radial side of the ring finger may also be present at times.
Common exam findings: Classic exam findings include a positive Tinel's Test at the wrist and positive Phalen's Test. In advanced cases you may find sensory deficits to the areas the median nerve innervates or atrophy of the thenar eminence and weakness of the abductor pollicis brevis and difficulty with thumb opposition.
Tests and treatment: Treatment includes avoidance of the repetitive wrist activities that may be contributing to the symptoms and consideration of splinting. Occupational therapy or injections into the carpel tunnel can also be considered. In resistant cases or those with evidence of neurologic deficit an EMG should be performed to evaluate for potential surgical decompression.