Carpal Tunnel Syndrome: The Daily PANCE Blueprint
A 30-year-old female with a history of obesity presents to the clinic with right wrist pain that is worse at night. She also says it feels weak and is "tingling." The patient says it started hurting more when she started a new office job. On physical exam, tapping over the palmar surface of the wrist produces an electric sensation along the distribution of the median nerve. What sign/test is she positive for?
A. Durkan test
B. Phalen sign
C. Schober test
D. Tinel sign
E. Finkelstein test
Answer and topic summary
The answer is D. Tinel sign
Carpal tunnel syndrome is defined by compression of the median nerve. Symptoms include hand weakness, nocturnal pain, and paresthesias of the hand (usually in median-nerve distribution). Some risk factors include prolonged postures of wrist flexion, pregnancy, obesity, hypothyroidism, and RA. Physical exam may show:
– Durkan compression test: Compression of median nerve @ carpal tunnel for 30 seconds causes symptoms
– Phalen sign: Holding the wrist in a flexed position for 60 seconds leads to paresthesias
– Tinel sign: Tapping over the palmar surface of the wrist produces an electric sensation along the distribution of the median nerve
Diagnosis is usually clinical. Treatment includes night splinting and local steroid injection. Surgical decompression can be done for refractory cases.
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Covered under ⇒ PANCE Blueprint Neurology ⇒ ⇒
