Describe the Martin-Gruber anastomosis and how this variant can cause confusion when examining for nerve injuries. Rodney is a physical therapy student with you that week shadowing you as you see patients. She has a history of recent onset rheumatoid arthritis. Not surprisingly, you note a positive Phalen s test and Tinel s sign on exam. You tell her she probably has carpal tunnel syndrome.
Carpal tunnel is the most common neuropathy in the upper extremity.
The disorder was first described by Sir James Paget in 1854 and the pathology was noted in 1913. Phalen et al dubbed it a clinical syndrome in the 1950s. Patients who have mild symptoms, usually sensory symptoms without motor deficit, may be treated conservatively. This includes the use of splints, in neutral position, and nonsteroidal antiinflammatory drugs. Studies have shown that volar or dorsal flexion of the wrist can increase the pressure within the carpal canal.