Basics
- Most common entrapment neuropathy in the upper extremity
- Usually occurs in middle-aged patients that have performed repetitive hand motions
- Commonly presents as a painful, numb feeling in the hand or hands
- Weakness is common
- Can be managed with medication or surgically
Symptoms and Signs
- Dysethesias- patients are normally awoken with a painful, numb feeling in the hands (feels like your hands are asleep) of a specific distribution
- Weakness of the grip- may see some atrophy
- Clumsiness and changes in handwriting or difficulty buttoning buttons (more a result of numbness)
- Positive Phalen’s and Tinel’s signs
Demographics
- 4:1 Female to Male normally in middle-aged patients
Diagnosis
- EMG and nerve conduction velocity
- If the diagnosis is unclear blood test may be required: Thyroid function testing (to rule out myxedema), CBC and 24hr urine (multiple myeloma), electrolytes and BUN/Cr (uremic neuropathy)
- Carpal tunnel is also common in pregnancy and tuberculosis
Treatment
- Medications: NSAIDS and steroid injections (1/3 will relapse)
- Splints- 50% will improve with splinting alone
- Surgery- the definitive treatment though not all patients are surgical candidates
Prognosis
- 90% of patients treated surgically will have improvement
Differential Diagnosis
- Cervical radiculopathy
- Thoracic outlet syndrome
- Pronator teres syndrome- entrapment of the median nerve in the upper forarm
- de Quervain’s syndrome- also common in pregnancy
- Reflex sympathetic dystrophy
- Tenosynovitis