Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Carpal tunnel syndrome (CTS) is caused by compression of the median nerve as it passes through the carpal tunnel
  • Results in pain, paresthesias, and sometimes weakness in the hand
  • Can be acute or chronic
  • The carpal tunnel is bound by the carpal bones and the transverse carpal ligament (flexor retinaculum)
  • The median nerve and tendons of flexor digitorum profundus (FDP), flexor digitorum superficialis (FDS), and flexor pollicis longus pass through the carpal tunnel
  • Prevalence: 1–5%; women > men

Etiology

  • Acute:
    • Trauma (particularly with distal radius and carpal fractures)
    • Infection (cellulitis, septic arthritis, viral syndrome)
    • Inflammatory (gout, rheumatoid arthritis)
    • Hemorrhage
    • Iatrogenic
  • Chronic:
    • Occupational/overuse syndromes – high impact, repetitive motion
    • Trauma can have delayed presentation from median nerve contusion or alteration in anatomy from atypical healing
    • Pregnancy, birth control pills, aromatase inhibitors
    • Granulomatous disease: Tuberculosis, sarcoidosis
    • Mass lesions with median nerve compression
    • Anatomic anomalies (e.g., persistent median artery, venous malformation)
    • Amyloidosis
    • Endocrine disorders: Hypothyroidism, diabetes mellitus, acromegaly
    • Chronic hemodialysis
    • Idiopathic

Pediatric Considerations
Rare in children; most common causes:
  • Trauma
  • Mucolipidosis and mucopolysaccharidosis
  • Hemophilia with wrist hematoma

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Basics

Description

  • Carpal tunnel syndrome (CTS) is caused by compression of the median nerve as it passes through the carpal tunnel
  • Results in pain, paresthesias, and sometimes weakness in the hand
  • Can be acute or chronic
  • The carpal tunnel is bound by the carpal bones and the transverse carpal ligament (flexor retinaculum)
  • The median nerve and tendons of flexor digitorum profundus (FDP), flexor digitorum superficialis (FDS), and flexor pollicis longus pass through the carpal tunnel
  • Prevalence: 1–5%; women > men

Etiology

  • Acute:
    • Trauma (particularly with distal radius and carpal fractures)
    • Infection (cellulitis, septic arthritis, viral syndrome)
    • Inflammatory (gout, rheumatoid arthritis)
    • Hemorrhage
    • Iatrogenic
  • Chronic:
    • Occupational/overuse syndromes – high impact, repetitive motion
    • Trauma can have delayed presentation from median nerve contusion or alteration in anatomy from atypical healing
    • Pregnancy, birth control pills, aromatase inhibitors
    • Granulomatous disease: Tuberculosis, sarcoidosis
    • Mass lesions with median nerve compression
    • Anatomic anomalies (e.g., persistent median artery, venous malformation)
    • Amyloidosis
    • Endocrine disorders: Hypothyroidism, diabetes mellitus, acromegaly
    • Chronic hemodialysis
    • Idiopathic

Pediatric Considerations
Rare in children; most common causes:
  • Trauma
  • Mucolipidosis and mucopolysaccharidosis
  • Hemophilia with wrist hematoma

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