Carpal Tunnel Syndrome symptoms and treatment - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes a patient complaining of hand numbness and weakness - carpal tunnel syndrome

History of a patient with hand numbness and weakness
52-year-old female who works as a secretary and is right-handed and has been complaining of right hand numbness and weakness that has been annoying her for the last 6 months. There is no history of trauma or injury. Prolonged typing makes her hand numb. Her primary care doctor has given her anti-inflammatory medication and a carpal tunnel splint for the last 4 months. The patient did not improve and in fact, the pain awakens her at night. There are some thenar atrophy. On examination, the patient has decreased sensation on the volar aspect of the thumb and index fingers. Patient had a positive Tinel's sign (electric shock type sensation) which radiates to the thumb and index finger. Durkan's compression test and maximum flexion of the wrist worsens the symptoms. In the Phalen's test, the patient maximally flexes both wrists against each other, and holds that position for about 1 minute. The diagnosis is carpal tunnel syndrome! The carpal tunnel is like a tunnel and if there is any increase in the volume of the tunnel which can occur from inflammation or edema, then there will be pressure on the nerve that lies within the tunnel. That limits the blood flow within that segment of the nerve leading to symptoms of nerve compression (numbness, paresthesia). The symptoms usually arise secondary to crowding of the median nerve which will cause local compression. X-ray is normal. In some cases where it is difficult to tell, you do nerve studies to confirm or to exclude the diagnosis. The EMG may be negative in about 15% of patients with carpal tunnel syndrome (false negative). EMG shows slowing of the median sensory and motor distal latencies. The median to ulnar latencies are usually compared to rule out the possibility of peripheral neuropathy, which can be another cause of the slowing at the median nerve.
So, what are the signs of median nerve compression? And can the patient self diagnose themselves?
Symptoms related to median nerve distribution
• Night pain
• Positive Tinel's sign
• Positive Phalen's test
• Positive Durkan’s test
If the patient presents with 3 of these 4 symptoms, then carpal tunnel syndrome is probable.
Treatment is usually immobilization, anti-inflammatory medication use to decrease the swelling, injections can be helpful and if the injection works, then surgery will probably be successful. If the symptoms are not resolved by conservative treatment, then surgery by carpal tunnel release is indicated.

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