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Case 15: Hand pain and numbness

This lady has had pain and numbness in the radial three fingers for over 20 years. These symptoms are worse at night time. She ofetn wakes at night and shakes her hands for relief.

1. What syndrome is this typical of?

Carpal tunnel syndrome

2. What complication is seen?

Thenar muscle wasting.

2. Confirmatory tests?

Nerve conduction studies - are always helpful to exclude other diagnoses.

2. Treatment?

Conservative - splints, analgesia, treatment of any predisposing cause, steroid injection into and around the carpal tunnel. All of these would be unsuitable in this case because of the significant symptoms and demonstrable thenar muscle wasting.

Surgery - Open or endoscopic division of the flexor retinaculum. A 'carpal tunnel release'