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What is it?
Carpal tunnel is compression of the medial nerve as it passes through the carpal tunnel in the wrist.
Symptoms
Pins and needles in the palmar side of the thumb, index and middle fingers of the hand (not involving the thenar eminence). There may also been pain at the flexor crease of the wrist. Frequently sleep is disturbed due to the pins and needles sensations.
Incidence
CTS is a relatively common condition estimated to affect approximately 0.5% of workers. In high risk industries (Eg sewing machining operation, abattoir workers and leather tanning workers it can be as high as 15%).
Possible Contributing Causes
Dr Ross Mills suggests the following as possible causes:
Diseases and altered health states such as rheumatoid arthritis, collagen – vascular disorders, diabetes, thyroid disease, renal disease, amyloidosis, pregnancy, obesity, alcoholism, endocrinopathies, gout, dupuytren’s disease, space occupying lesions and small wrist dimensions.
Repeated extreme wrist flexion or extension
Repeated forces on the base of the palm and wrist
Use of vibratory hand tools
Differential Diagnosis:
Cervical spine dysfunction
Thoracic outlet syndrome
Previous fracture/trauma to the wrist
Connective tissue disorders
Overuse syndrome
Tenosynovitis of wrists and elbows
Red flag conditions:
Muscle atrophy
Significant impairment of activities of daily living
Altered finger/hand profusion
Objective neurological deficits
Systemic signs/symptoms
Sudden onset of symptoms
Yellow flag conditions:
Attitudes and beliefs about pain
Emotions
Behaviours
Family
Compensation issues
Work
Diagnostic and treatment issues
Workplace conflicts
Recommended treatment investigations include nerve conduction studies, FBC, rheumatology screen, Thyroid Function testing, uric acid and glucose.
Possible alternate duties (Dr Ross Mills):
No repetitive/tight gripping with the (affected hand)
Maximum lift 5 kgs
Avoid over hand gripping with the affected hand
Avoid bending the affected wrist
Avoid using impact or vibration tools with the affected hand
Avoid pressure to the base of the palm and wrist of the affected hand
When to Consider Referral for a Specialist Opinion
The presence of any red flag conditions
The worker has had more than two weeks certified unfit for duties, or more than one month on selected duties
The worker has had more than three weeks off work, or on selected duties and has significant yellow flag conditions
Not back at pre-injury duties within six weeks of the injury