Case 61 Carpal Tunnel Syndrome



W. Kelsey Snapp and Reena A. Bhatt

Case 61 Carpal Tunnel Syndrome

Case 61 A 73-year-old right-hand-dominant male presents with a 2-year history of increasing numbness of the thumb, index, and middle fingers of the right hand. He also reports worsening weakness and clumsiness.



61.1 Description




  • Paresthesias reported in the median nerve distribution of the right hand



  • Significant thenar atrophy of the hand relative to the contralateral side



61.2 Work-Up



61.2.1 History




  • Duration and evolution of symptoms



  • Prior treatments and their effectiveness



  • Pertinent symptoms consistent with nerve compression




    • Nocturnal pain, numbness, and tingling in the thumb and one or more radial fingers



    • Daytime paresthesias elicited with activities involving prolonged wrist flexion and/or extension



    • Need for shaking and wringing the hand to alleviate symptoms



    • Gritty sensation or numbness in fingers, grip and pinch weakness, and diminished finger dexterity with a history of dropping objects



    • Cold intolerance, dryness, and unusual textures in the radial digits



  • History of neck injuries or pain should be elicited (evaluate for more proximal issues)



61.2.2 Physical Examination




  • Tinel sign: Examiner percusses over the carpal tunnel. Tingling over distribution of the median nerve indicates positive result.



  • Phalen maneuver: Patient maintains full flexion of wrists for 30 to 60 seconds. Result is positive if tingling, burning, or numbness of the thumb, index, long, or ring finger is elicited.



  • Durkan’s (carpal compression) test: Examiner applies pressure with thumbs over the carpal tunnel for 30 seconds. Onset of pain/paresthesias in the median nerve distribution within 30 seconds is a positive result.



  • Diminished (increased) two-point discrimination compared to the ulnar nerve and contralateral hand. The normal distance is 4 to 6mm. Semmes-Weinstein monofilament testing or vibrometry.



  • Weakness and/or atrophy of the thenar musculature and radial lumbrical; atrophy and burning are later signs



  • Examination of soft tissues for skin and muscle atrophy, manual muscle strength testing, grip and pinch testing, percussion of all major peripheral nerves, assessment of deep tendon reflexes, and assessment of blood flow to each hand



  • Cervical spine and entire upper extremity examination to rule out cervical radiculopathy or thoracic outlet syndrome

Only gold members can continue reading. Log In or Register to continue

Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 61 Carpal Tunnel Syndrome
Premium Wordpress Themes by UFO Themes