Carpal tunnel syndrome

Carpal tunnel syndrome (CTS) occurs when the median nerve is compressed at the wrist in the carpal tunnel which causes symptoms of tingling and numbness in the thumb, index, middle and radial half of the ring finger. Longstanding CTS can result in thenar muscle atrophy. CTS is the commonest form of nerve entrapment. Symptoms tend to worsen during the night or during activities such as driving, holding a telephone or reading. The condition is more common in women than in men. This condition is often seen in pregnant or post partum females.

Mechanism of onset, location of symptoms (median nerve distribution??), severity and longevity of symptoms, limitation to function.

1. Light touch, sensory testing tips of fingers
2. Phalen’s, Tinel’s and Durkan’s test can support the diagnosis.
   • Wrist and hand exam: Durkan's and carpal tunnel compression test for carpal tunnel syndrome (YouTube)
   • Carpal tunnel syndrome - Tinel's sign and Phalen's sign - clinical examination (YouTube)

Nerve conduction studies are not indicated in primary care.

• Cervical spine/ radiculopathy
• Diabetic polyneuropathy.

• Treatment of any underlying condition, e.g. diabetes, OA, RA, hypothyroidism, Vit B12 deficiency
• Patient education, activity modification – NHS Ayrshire & Arran CTS leaflet
• Night splinting of wrist in a neutral position.

• Diagnostically uncertain
• Symptoms persist beyond 2- 3/12 and interfere with ADL’s ***consider severity
• Exceptionally severe symptoms

If suspect a non red flag cervical source suspected, particularly if bilateral symptoms – refer to Physiotherapy through usual pathway.