pinched nerve syndrome
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A syndrome of painful paraesthesiae of the median nerve, affecting hands and fingers, in particular index, middle and ring fingers, 2º to fibrous adhesions in the CT; it is most common in women; if prolonged, the CTS may result in partial atrophy of the lateral half of the thenar eminence with weakness of abduction and opposition of the thumb; it is either a chronic idiopathic flexor tenosynovitis, repetitive stress syndrome, or part of systemic conditions—e.g., acromegaly, amyloidosis, diabetes, granulomatous disease, hypothyroidism, mucopolysaccharidosis I-S, myxedema, obesity, pregnancy, or local processes, including ganglion cyst, bone dislocations, lipoma, callus formation in wrist fractures—e.g., Colles or Smith fractures—gout, pseudogout, and rheumatoid arthritis causing flexor tenosynovitis
Examination Phalen sign, Tinel sign
Diagnosis EMG is ‘gold standard’ test; detects decreased conduction velocity
DiffDx Proximal sites of nerve entrapment—e.g., Pancoast tumour, pronator teres syndrome
Treatment, early Wrist splint, NSAIDs, corticosteroid injection—e.g., beta-methasone—yoga
Treatment, late Longitudinal section of epineurium and flexor retinaculum for thenar atrophy
