Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Carpal Tunnel Syndrome

SYMPTOMS

There is paraesthesia of the radial three and a half fingers and pain around the wrist. Often, sleep is disturbed.

AETIOLOGY

These symptoms are caused by chronic compression of the median nerve in the carpal tunnel by a hypertrophied flexor tendon retinaculum.

CLINICAL FINDINGS

There is tenderness on palpation over the carpal tunnel and a positive Tinel’s sign. In severe cases there is atrophy of the thumb muscles.

INVESTIGATIONS

Nerve conduction test is usually positive.

TREATMENT

NSAID and physiotherapy including stretching of the flexor muscles may be sufficient to relieve symptoms. The cause for the onset should be found and addressed. Surgery, with release of the retinaculum, is required in severe cases.

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon and specialist if there is long duration of progressive symptoms or if the diagnosis is not clear. Physiotherapy, with exercises and stretching, is indicated.

EXERCISE PRESCRIPTION

Most sports can be maintained but avoid static dorsi-flexion such as holding a handlebar on a bicycle. After surgery the symptoms are usually relieved almost immediately and most activities can be back to normal within six weeks. Running, cycling and swimming (when the wound is healed after surgery) are good alternatives to keep up general fitness. Gym training can be maintained.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs and negative Tinel’s sign.

DIFFERENTIAL DIAGNOSES

This is a clear clinical diagnosis.

PROGNOSIS

Excellent, if treated appropriately. If it is missed, surgery can be performed at a later stage.

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