Carpal tunnel syndrome involves?
Correct Answer: Median nerve
Description: CARPAL TUNNEL SYNDROME:- Compression of the median nerve in the carpal tunnel. It is a common entity. This syndrome consists of motor, sensory, vasomotor and trophic symptoms in the hand caused by compression of the median nerve in the carpal tunnel. Examination reveals wasting of thenar eminence{ape like hand}, hypoaesthesia to light touch on the palmar aspect of lateral 3 1/2 digits. However, the skin over the thenar eminence is not affected as the branch of the median nerve supplying it arises in the forearm. Froment's sign/ book holding sign: The patient is unable to hold the book with thumb and other fingers. PAPER HOLDING TEST: The patient is unable to hold the paper between thumb and fingers. MOTOR CHANGES: Ape/monkey like thumb deformity, loss of opposition of the thumb. Index and middle fingers lag behind while making the fist due to paralysis of1st and 2nd lumbar muscles. SENSORY CHANGES: Loss of sensations on lateral 3 1/2 digits including nail beds and distal phalanges on the dorsum of the hand. VASOMOTOR CHANGES: The skin areas with sensory loss is warmer due to aeriolar dilatation; it is also drier due to the absence of sweating due to loss of sympathetic supply. TROPHIC CHANGES: Long-standing cases of paralysis lead to dry and scaly skin. The nails crack easily with atrophy of the pulp of fingers. It occurs both in males and females between the age of 25 and 70. They complain of intermittent attacks of pain in the distribution of the median nerve on one or both sides. The attacks frequently occur at night. Pain may be referred proximally to the forearm and arm. It is more common because of excessive working on the computer. Phalen's test is attempted for CTS. {Reference: BD Chaurasia page no:130,}
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