CARPAL TUNNEL SYNDROME

Classic Presentation

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Patients with carpal tunnel syndrome presents with a complaint of pain and numbness/tingling in the palmar surface of the thumb, the index finger and half of the middle finger; the symptoms are worse at night. 


Cause

The median nerve runs through an osteofibrous tunnel created by the transverse carpal ligament and carpal bones.  Although direct compression from ganglion cysts, fractures and dislocations is possible, it is more common to have a history of direct external pressure on the tunnel or history of prolonged wrist use in full flexion or extension.  Pressure inside the tunnel increases in these extreme positions.  Additional factors may have to do with fluid retention, as in pregnancy, rheumatoid arthritis, diabetes, and connective tissue disorders.  Patients deficient in B vitamins may be predisposed. 

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