MRCP revision battle 42.3: Carpal tunnel syndrome

Carpal tunnel syndrome is a mononeuropathy of the median nerve at the carpal tunnel = space under the transverse carpal ligament and above the carpal bones.


It is the commonest mononeuropathy.


Classical presentation is pain in hand and arm with paraesthesia in thumb, index and middle fingers.  The pain is often worse at night and is relieved by dangling the hand out of bed and shaking it.


'Bedside tests' include:

• Phalen's test = maximal wrist flexion ('praying') for 1 minute recreates symptoms
• Tinel's test = tapping over nerve at wrist recreates symptoms

(I remember which way round these tests go by thinking 't for tapping, t for tinel)


Associations with carpal tunnel syndrome include:

• diabetes
• acromegaly
• hypothyroidism
• pregnancy
• RA

 Management may be conservative, spliting, steroid injections or surgery.


Now on to some diabetic neuropathy...