Pathophysiology
entrapment of median nerve within carpal tunnel in the wrist
Signs and Symptoms
1) nighttime paresthesias and numbness in thumb, forefinger, and half of middle finger 2) weakness and atrophy of abductor pollicis brevis (thenar eminence) 3) positive Tinel’s test 4) positive Phalen’s test
Associated Conditions
increased incidence with – 1) jobs with repetitive hand or arm motion 2) diabestes 3) acromegaly 4) hypothyroidism 5) amyloidosis (owing to amyloid infiltration of flexor retinaculum) 6) rheumatoid arthritis 7) eosinophilic fasciitis 8) osteoarthritis 9) pregnancy
Treatment
1) surgical resection of carpal ligament 2) in pregnancy, condition usually resolves after delivery and nighttime splints are used
Tips for USMLE
1) Phalen’s sign is paresthesias occurring when placing the extensor surfaces of the flexed wrists together 2) Tinel’s sign is paresthesias when the volar surface of the wrist is tapped firmly
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