Carpel tunnel syndrome

Inspection:

• weak flexion of thumb, 1st and 2nd finger - benediction sign
• wasting of thena muscle
• lumricals
• opponens pollicis
• abductor pollicis brevis
• flexor pollicus brevis

 Palpation:

• weakness
• tinel sign
• sensation:
• decreased over medial side
• +/- loss of sensation over palmar cutaneous branch (exit before carpal tunnel)
  

Phalen and anti-phalen test
direct compression

cause of median nerve compression:

• carpal tunnel
• pronator syndrome - at cubital tunnel by ligament of struthers
  
• anterior osseus nerve - compression at deep origin of pronator teres; only motor (loss of pinch 'OK sign'), no sensory deficit.

managment:

• conservative
• surgery - open VS endoscopic