tingling sense in the distribution of median N.Phalen's test- hyperextension/ flexion aggravates pain & paresthesiaCuff compression test of Gilliatt & Wilson- BP cuff is inflated above systolic BP-> aggravates pain & paresthesia.CARPAL TUNNEL SYNDROMEMost common upper extremity compressive neuropathyNeuropathy caused by compression of the median nerve within the carpal tunnel.The floor of the tunnel is formed by the volar radiocarpal and intercarpal ligaments.The transverse carpal ligament forms the roof of the tunnel.9 long flexors of the wrist and fingers and median nerve run within this spatially limited and relatively rigid tunnel.Etiology: PRAGMATICP-PregnancyR-Rheumatoid arthritisA-Arthritis degenerativeG-Growth hormone abnormalities (acromegaly)M-Metabolic (gout, diabetes myxedema, etc)A-AlcoholismT-Tumorsl-ldiopathicC- Connective tissue disorders (e.g. amyloidosis).Thus, any increase in pressure within the tunnel compresses the injury-prone median nerve.A decrease in thenar muscle strength occurs, along with a numbness or a decrease in the sensibility of the palmar surface of the radial 3 1/2 digits, especially the middle and index fingers.Initial stage:Dull pain in the arm at night (brachialgia paresthetica nocturna)Wakes the patient from sleep and can be relieved by shaking and massaging the armsStiff & uncoordinated fingers for a short time after the patient wakes up in the morningAdvanced stage:Abnormal sensations (paresthesia) developSense of touch is impaired, mainly in the thumb and index finger.The Phalen wrist flexion sign or Phalen maneuver is positive in carpal tunnel syndrome.Inability to oppose the thumbs.Emaciation of thenar eminenceParesthesia, hypoesthesia, or anesthesia of lateral three and a half digits.Sensation in the central palm remains unaffected.TESTS:Provocative testing includes Phalen's test, Tinel's test at the wrist, or the carpal tunnel compression test (Durkan's test).The carpal tunnel compression test is generally regarded as the most sensitive.The most predictable sensory test to evaluate carpal tunnel syndrome is the Semmes-Weinstein monofilament test.">