Carpal Tunnel Syndrome

Median nerve compression at wrist (transverse carpal ligament). Features: numbness / tingling in lateral 3.5 fingers (thumb, index, middle, lateral half of ring), worse at night (wakes patient), often relieved by shaking hand. Loss of fine motor (buttons, opening jars). Thenar wasting in advanced. Risk: female, pregnancy, obesity, diabetes, hypothyroidism, RA, repetitive activity, prior wrist trauma. Examination: • Tinel sign at wrist (tap over median nerve — paraesthesia). • Phalen sign (wrist flexion 1 min — paraesthesia). • Carpal compression test (most sensitive). • Two-point discrimination, sensation, thenar atrophy + opposition strength. Nerve conduction studies — gold standard for diagnosis + severity (mild / moderate / severe / very severe). Workup: TFTs, glucose, BMI; pregnancy test if relevant.