Carpal Tunnel Syndrome (CTS):

• A compressive neuropathy of the median nerve at the wrist as it travels through the carpal tunnel. 
• Median nerve is bound on three sides by carpal bones and anteriorly by the transverse carpal ligament.  Surgical repair typically consists of cutting this ligament to allow decompression of the nerve.
• The neuropathy results in:
  • parasethesia of the thumb, index and middle fingers
  • weaknesss of the thumb and thenar muscles.
• NO physical exam test has great senstivity or specificity for CTS. The two most common are:
  • Phalen's test: hyperflexion of the wrist. Need to hold for 60 seconds.  Sensitivity ~68% and Specificity ~73%
  • Tinel Sign: tapping over cubital tunnel to produce parasthesia along the median nerve. Sensitivity ~50% and Specificity ~77%.
• Increased risk in those patients with:
  • Diabetes
  • Rheumatoid arthritis
  • hypothyroidism
  • amyloidosis