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CONDITION/SYNONYM

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  • Carpal tunnel syndrome (CTS)

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ICD-9-CM CODE

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  • 354.0 Carpal tunnel syndrome

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ICD-10-CM CODES

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  • G56.01 Carpal tunnel syndrome, right upper limb

  • G56.02 Carpal tunnel syndrome, left upper limb

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PREFERRED PRACTICE PATTERNS

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  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated withLocalized Inflammation1

  • 5F: Impaired Peripheral Nerve Integrity and Muscle Performance Associated with Peripheral Nerve Injury2

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PATIENT PRESENTATION

A 42-year-old woman presents with complaints of paresthesias(tingling and lately burning) and occasional pain and numbness in the right thumb, index, and middle fingers. Symptoms were initially intermittent, but becoming more constant, and the pain now often wakes her at night. In addition, recently she has noticed a loss of grip strength and has dropped objects on occasion. Onset was gradual, and symptoms worsening. She first saw her family physician 3 months ago for the numbness and tingling. The patient is a check-out clerk at a local grocery store. She is right-handed; BMI is 40.

On physical examination, sensory testing shows diminished touch and vibration sensation, and decreased two-point discrimination on the palmar surface of the thumb, and index, middle, and radial half of the ring fingers. Phalen and Tinel tests are positive. Thumb abduction, flexion, and opposition strength are only 4/5. Nerve conduction test done last week shows decreased nerve conduction velocity of the median nerve across the right wrist.

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KEY FEATURES

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Description
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  • Entrapment neuropathy of the median nerve within the carpal tunnel of the wrist3,4

  • Signs and symptoms typical of neuropathy, including

    • Pain

    • Paresthesias

    • Loss of sensation

    • Later loss of muscle function

  • Symptoms are seen in the distribution of the median nerve in the hand3

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FIGURE 217-1

The wrist. (A) Topography of the wrist joint. (B) Motions of the wrist joint. (From LeBlond RF, DeGowin RL, Brown DD. DeGowin’s Diagnostic Examination. 9th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
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Essentials of Diagnosis
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  • Pain, paresthesias, and sensory loss perceived on the radial side of the palm; the palmar side of the thumb, index, and middle fingers; and the radial side of the ring fingers

  • Pain may radiate up to the elbow, shoulder, and neck

  • Waking from pain at night is hallmark of this condition5

  • In advanced cases, motor dysfunction in thenar muscles may occur, characterized by weakness, atrophy, loss of coordination

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General Considerations
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  • In entrapment neuropathy, nerve becomes compressed, causing ischemic damage to the nerve

  • The carpal tunnel is a constrained area at the wrist boundedby the carpal bones and the transverse carpal ligament(flexor retinaculum)3

  • The median nerve and nine ...

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