Carpal Tunnel Syndrome (CTS)
Carpal Tunnel Syndrome is the most common entrapment neuropathy in the body. It involves compression of the Median Nerve as it passes beneath the transverse carpal ligament (Flexor Retinaculum).
[Image of Carpal Tunnel Anatomy Median Nerve]1. Anatomy
- The Tunnel Contents (10 structures):
- 1 Nerve: Median Nerve.
- 9 Tendons: 4 FDS, 4 FDP, 1 FPL.
- Roof: Transverse Carpal Ligament.
- Floor: Carpal Bones.
2. Clinical Features
- Symptoms: Numbness/Tingling in lateral 3.5 fingers. Night pain (shaking hands relieves it).
- Severe Signs: Thenar Muscle Wasting (Ape Thumb deformity).
3. Special Tests
Phalen's Test: Wrist flexion for 60 seconds (reproduces symptoms).
Tinel's Sign: Tapping over the nerve causes electric shock sensation.
Durkan's Test: Direct compression (Most sensitive).
Tinel's Sign: Tapping over the nerve causes electric shock sensation.
Durkan's Test: Direct compression (Most sensitive).
4. Management
- Conservative: Night splints (Neutral wrist), NSAIDs, Steroid injection.
- Surgical: Carpal Tunnel Release (Cutting the Transverse Carpal Ligament).
25 Practice MCQs
Q1. Which nerve is compressed in CTS?
Answer: A). Supplies sensation to thumb, index, middle, and half ring finger.
Q2. The roof of the carpal tunnel is formed by:
Answer: A). This is the structure cut during surgery.
Q3. Phalen's Test involves:
Answer: A). Increases tunnel pressure.
Q4. Thenar wasting affects which muscles?
Answer: A). "LOAF" muscles (Lumbricals 1/2, Opponens, APB, FPB). Adductor is Ulnar nerve.
Q5. Night splints should hold the wrist in:
Answer: A). Lowest tunnel pressure is at neutral.
Q6. Which tendon passes through the tunnel?
Answer: A). FCR runs in its own separate tunnel.
Q7. Sensation to the palm (Thenar eminence) is often spared because:
Answer: A). Key differential sign (Pronator syndrome affects palm).
Q8. "Ape Hand" deformity is loss of:
Answer: A). The thumb falls into the plane of the palm.
Q9. The most sensitive clinical test is:
Answer: A). Direct pressure over the carpal tunnel.
Q10. Double Crush Syndrome involves:
Answer: A). Proximal compression makes distal nerve more susceptible.
Q11. Pregnancy is a risk factor due to:
Answer: A). Usually resolves postpartum.
Q12. The "Million Dollar Nerve" refers to:
Answer: A). If cut during surgery, thenar function is lost (high liability).
Q13. EMG/NCS is useful to:
Answer: A). Gold standard for objective confirmation.
Q14. Vitamin B6 (Pyridoxine) is:
Answer: A). Some studies suggest deficiency plays a role.
Q15. Endoscopic release has the advantage of:
Answer: A). But slightly higher risk of nerve injury if not skilled.
Q16. Acute Carpal Tunnel Syndrome is caused by:
Answer: A). Surgical emergency requiring immediate release.
Q17. Semmes-Weinstein Monofilament test measures:
Answer: A). 2.83 is normal.
Q18. "Pillar Pain" is:
Answer: A). Due to loss of the ligament tie-bar effect.
Q19. Hypothyroidism contributes to CTS by:
Answer: A). Common systemic cause.
Q20. Which finger is NOT affected in pure CTS?
Answer: A). Little finger is purely Ulnar nerve. (Ring finger is split 50/50).
Q21. What is the "Flick Sign"?
Answer: A). Very reliable historical sign.
Q22. Tendon gliding exercises help prevent:
Answer: A). Nerve gliding is also prescribed.
Q23. Pronator Teres Syndrome differs from CTS because:
Answer: A). Compression is at the elbow/forearm.
Q24. Recurrence after surgery is often due to:
Answer: A). Most common cause of failure.
Q25. Bilateral CTS is a red flag for:
Answer: A). Always investigate further.
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