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Carpal tunnel syndrome - Nail and Distal Digit
See also in: Overview
Other Resources UpToDate PubMed

Carpal tunnel syndrome - Nail and Distal Digit

See also in: Overview
Contributors: Shari Lipner MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Carpal tunnel syndrome is a common condition affecting 10% of the population at some time during their life. Prevalence estimates range from 0.1%-0.6% of the population. It preferentially affects people who do manual labor or have hobbies with extensive hand / digit involvement. Carpal tunnel syndrome is caused by median nerve compression within the carpal tunnel (a narrow passageway formed by bones and ligaments on the palmar surface or the hand / wrist), and this may affect sensory, motor, and autonomic neural functions of the median nerve. Patients present with pain and paresthesias affecting the first three digits.

Mild carpal tunnel syndrome is typically not associated with dermatologic findings. When long-standing, autonomic nerve dysfunction occurs, resulting in necrotic carpal tunnel syndrome. Dermatologic manifestations will then include bullae, ulcers, hypohidrosis, vasospasm, and Raynaud phenomenon. Nail changes may also occur and may be a clue to diagnosis of carpal tunnel syndrome.

Nail changes are more common in women, with a median age of 54 years. The right hand is more often involved than the left.

There are case reports of carpal tunnel-associated nail changes in children and young adults; however, it is very rare in children. For late stage carpal tunnel syndrome presenting in children, genetic or metabolic causes should be explored, although there are reports of sporadic cases. These include lysosomal storage diseases (familial thickening of the transverse ligament and diabetes mellitus). Other reported causes are repetitive wrist motion, median nerve fibrolipomas or hemangiomas, hemophilia, automutilation, and trauma.

Codes

ICD10CM:
G56.00 – Carpal tunnel syndrome, unspecified upper limb

SNOMEDCT:
57406009 – Carpal tunnel syndrome

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed:05/25/2020
Last Updated:05/31/2020
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Carpal tunnel syndrome - Nail and Distal Digit
See also in: Overview
Imaging Studies image of Carpal tunnel syndrome
Axial intermediate weighted MRI sequence demonstrates inflammation surrounding the flexor tendons within the carpal tunnel, with edema of the median nerve (shorter arrow).  Compatible with carpal tunnel syndrome.
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