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9.21 Carpal Tunnel Syndrome


The patient complains of pain, tingling, or a "pins and needles" sensation in the hand. Onset may have been abrupt or gradual but the problem is most noticeable upon awakening or after extended use of the hand. The sensation may be bilateral, may include pain in the wrist, or forearm and is usually ascribed to the entire hand until specific physical examination localizes it to the median nerve distribution. More established cases may include weakness of the thumb and atrophy of the thenar eminence. Physical examination localizes paresthesia and decreased sensation to the median distribution (which may vary) and motor weakness, if present, to intrinsic muscles with median innervation. Innervation varies widely, but the muscles most reliably innervated by the median nerve are the abductors and opponens of the thumb

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There is little space to spare where the median nerve and digit flexors pass beneath the volar carpal ligament, and a very little swelling may produce this specific neuropathy. Trauma, arthritis pregnancy, and weight gain are among the many factors which can precipitate this syndrome. Less commonly, the median nerve can be entrapped more proximally, where it enters the medial antecubital fossa through the pronator teres. Symptoms of this cubital tunnel syndrome may be reproduced with elbow extension and forearm pronation.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD