Definition
- Median nerve compression at level of flexor retinuculum
Etiology
- Primary cause: idiopathic
- Secondary causes:
- Space occupying lesions: tumors, hypertrophic synovial tissue, fracture callus, osteophytes
- Metabolic / physiological: pregnancy, hypothyroidism, acromegaly, RA
- Infections
- Neuropathies: associated with DM or EtOH
- Familial disorders
- Job/hobby related repetitive trauma – with forced wrist flexion
Female:male = 4:1
Symptoms:
- Sensory loss in median nerve distribution – radial 3.5 digits
- discriminative touch often lost first, then light touch and 2-pt discrimination, esp fingertips
- Pt awakened at night with numb/painful hand, relieved by shaking/dangling/rubbing
- Advanced cases: thenar wasting / weakness
Signs:
- Tinel’s sign (nerve percussion – tingling)
- Phalen’s sign (wrist flexion induces symptoms)
Clinical dx
- EMG may confirm, but don’t not exclude dx
Tx
- Avoid repetitive wrist and hand motion, wrist splints in neutral position at night
- NSAIDs, local corticosteroids injection, oral corticosteroids
- Surgical decompression: transverse carpal ligament incision
- Indication for Sx: numbness & tingling +/- sensory loss, weakness +/- mm atrophy, unresponsive to conservative measures
- C/I: injury to median motor branch, palmar cutaneous branch or superficial transverse vascular arch, local pain, scar formation
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