G56.01 Carpal tunnel syndrome, right upper limb
G56.02 Carpal tunnel syndrome, left upper limb
PREFERRED PRACTICE PATTERNS
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
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.
Entrapment neuropathy of the median nerve within the carpal tunnel of the wrist3,4
Signs and symptoms typical of neuropathy, including
Symptoms are seen in the distribution of the median nerve in the hand3
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.)
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
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 ...
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