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History: Sometimes, patients complain of an intermittent pins-and-needles
sensation in the median nerve distribution of the hand. This kind of sensation is
generally worse at night.
- Common symptoms of carpal tunnel syndrome are most often
bilateral, insidious in onset and progressive in nature.
- With advanced nerve compression, the aching sensation is
persistent and static and may radiate to the forearm and elbow.
Physical:
Tapping the volar wrist over the median nerve (Tinel's sign)
may produce paresthesias in the median distribution of the hand.
- Thenar atrophy may be present in advanced cases of carpal
tunnel syndrome (CTS).
- Hyperflexion of the wrist for 60 seconds may also elicit
paresthesias (Phalen's sign).
Causes:
- Activities involving repetitive wrist flexion, such as
assembly packing, computer keyboard work, playing a musical instrument and craftwork, can
cause inflammation of the flexor tendon sheath.
- Pregnancy or oral contraceptive-related related edema can
cause compression of the median nerve.
- Trauma of any type, including fractures, can cause edema that
can compress the median nerve.
- Tuberculosis
- Hemodialysis
- Hypothyroidism
- Amyloidosis
- Acromegaly
- Rheumatoid arthritis
- Gout
- Renal failure, diabetes mellitus and obesity have all been
associated with an increased risk of carpal tunnel syndrome.
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