C

ICD-9-CM Code

• 354.0 Carpal tunnel syndrome

ICD-10-CM Codes

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

Preferred Practice Patterns1

• 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Localized Inflammation
• 5F: Impaired Peripheral Nerve Integrity and Muscle Performance Associated with Peripheral Nerve Injury

Key Features

Description

• Entrapment neuropathy of the median nerve within the carpal tunnel of the wrist
• 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 hand

Essentials of Diagnosis

• 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

General Considerations

• 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

Demographics2

• 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

Clinical Findings

Signs and Symptoms

• 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

Functional Implications

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