The patient's history, examination, and nerve conduction velocity tests (normal distal sensory latency is <3.5 ms) are consistent with carpal tunnel syndrome.
Carpal Tunnel Syndrome is a common neuropathy affecting the peripheral median nerve caused by compression within the carpal tunnel. It is characterized by pain and paresthesias of the palm involving the wrist and/or volar aspect of the thumb, index finger, long finger, and the radial half of the ring finger. The patient often has feelings of clumsiness and weakness. Night pain and hypesthesia are also possible. Chronic carpal tunnel syndrome will lead to thenar muscle atrophy.
LeBlanc et al. report carpal tunnel syndrome is the most common entrapment neuropathy, affecting approximately 3 to 6 percent of adults in the general population. They note that most conservative treatments, including lifestyle modification and corticosteroid injections, provide short-term symptom relief, with little evidence supporting long-term benefits. They recommend patients with moderate to severe disease be considered for surgical evaluation.
Keith et al. discuss the Level 1 and 2 evidence supporting local steroid injection or splinting for the nonoperative treatment of carpal tunnel syndrome. The use of neutral wrist splints for carpal tunnel syndrome is most useful for improving night-time symptoms.
Illustration A demonstrates the phases of the action potential (AP) and the transmission of the potential. Changes in the AP are displayed on the horizontal axis, and changes in membrane potential(mV) are shown on the vertical axis. Illustration B shows an image of the median nerve in the carpal tunnel.
Answer 2: Cubital tunnel syndrome results from increased pressure on the ulnar nerve at the medial epicondyle.
Answer 3: The patient's symptoms are isolated to the median nerve and are not compatible with cervical myelopathy.
Answer 4: The patient's symptoms involve the median nerve, not the ulnar nerve.
Answer 5: Multiple sclerosis is an acquired demyelinating disease of the CNS that commonly presents with eye involvement such as MLF syndrome or optic neuritis.
LeBlanc KE, Cestia W. Carpal tunnel syndrome. Am Fam Physician. 2011 Apr 15;83(8):952-8. PubMed PMID: 21524035.
PMID:21524035 (Link to Abstract)
Keith MW, Masear V, Amadio PC, Andary M, Barth RW, Graham B, Chung K, Maupin K, Watters WC 3rd, Haralson RH 3rd, Turkelson CM, Wies JL, McGowan R. Treatment of carpal tunnel syndrome. J Am Acad Orthop Surg. 2009 Jun;17(6):397-405. Review.
PMID:19474449 (Link to Abstract)