Carpal Tunnel


  • 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


  • 4:1 Female to Male normally in middle-aged patients


  • 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


  • 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


  • 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