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  • 354.0 Carpal tunnel syndrome

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  • G56.01 Carpal tunnel syndrome, right upper limb
  • G56.02 Carpal tunnel syndrome, left upper limb

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Description

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Essentials of Diagnosis

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  • Pain, paresthesias, and sensory loss perceived on radial side of the palm and the palmar side of thumb, index, middle, and radial side of the ring fingers
  • Pain may radiate up to the elbow, shoulder, neck
  • Waking from pain at night is hallmark of this condition2
  • 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 bounded by the carpal bones and the transverse carpal ligament (flexor retinaculum)
  • The median nerve and 9 flexor tendons pass through the carpal tunnel
  • Pathomechanics involve decreased size of the tunnel or increased volume of the contents, causing compression on median nerve
  • Often associated with repetitive motions or sustained position of the wrist and hand
  • Unrelieved compression of the nerve results in neurapraxia with segmental demyelination further ischemic damage results in axonotmesis and wallerian degeneration

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Demographics2

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  • Incidence: 3.5 cases per 1,000 in general population
  • Prevalence: 2.1%
  • Most common entrapment neuropathy
  • More common in women than men (70% of cases are female)
  • 2.5 times more common in obese individuals
  • Most common among people aged 30 to 60 years
  • Nearly one-half of cases will experience bilateral symptoms

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Signs and Symptoms

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  • First symptom is usually pain or paresthesias; most commonly with gradual onset
  • Pain complaints include numbness (most common), tingling, burning
  • Pain or numbness waking the patient at night is very common
  • Pain is experienced in distribution of the median nerve in the hand, though may radiate up to elbow, shoulder, or neck
  • Tenderness to percussion or pressure over the carpal tunnel
  • Pain may be worse with extreme wrist flexion or extension
  • Sensory loss may follow early symptom of pain
  • Motor involvement (weakness, loss of coordination, atrophy) may follow in more advanced cases

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Functional Implications

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  • Pain with wrist movements
  • Difficulty with grasping and manipulation activities
  • Dropping items from the hand
  • Impaired sensation
  • Loss of strength in advanced cases

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Possible Contributing Causes

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  • Most often idiopathic
  • Genetic structural factors
  • Swelling of synovial tissues ...

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