Carpal tunnel syndrome

This is common. The typical patient awakens with painful tingling over the radial side of the hand; there is often loss of fine dexterity because of weakness of the abductor pollicis brevis muscle and altered sensation over the thumb, index and middle fingertips. On examination, Tinel’s percussion sign is positive over the carpal tunnel and Phalen’s test may be positive (tingling in the hand when the wrist is fully flexed). In advanced cases, the thenar eminence is wasted. The diagnosis, if not certain clinically, is confirmed with electrophysiology. Treatment includes splinting the wrist in extension at night, injecting steroid into the carpal canal and surgical release of the transverse carpal ligament.