Carpal Tunnel Syndrome
- Peripheral entrapment of the median nerve in the carpal tunnel.
- Patients typically complain of tingling, numbness, or pain in the distribution of the median nerve (the thumb, index, and middle fingers, and half the ring finger) often worse at night causing wakening.
- Examination may reveal wasting of the thenar muscles, and positive durkans / phalens / tinnels test.
- Differential includes C6/7 radiculopathy and generalised peripheral neuropathies.
- In cases of diagnostic uncertainty consider referral for electromyography and nerve conduction studies (not routinely required for referral).
- Explain that symptoms may resolve within 6 months esp in pregnancy and younger patients.
- Wrist splint – Best for acute presentations and mild to moderate symptoms without permenant numbness or pins and needles. Improvement should be apparent within 12 weeks.
- Steroid injection – if skilled, mild to moderate symptoms without constant numbness or muscle wasting.
- Referral Indications: Diagnostic uncertainty, Referral for EMG / NCS, Severe or progressive sensory / motor impairment, permanent numbness, muscle wasting Failure of mild to moderate symtoms to improve with 3 months non-operative measure.
- Nb – incidental findings of CTS on NCS/EMG do not require referral if patients are not symptomatic.