However, multiple aspirations may be required for resolution. If the cyst is painful or large or if there is a question of cause, orthopedic referral for surgical removal should be considered. Carpal tunnel syndrome. The symptoms are a result of median nerve dysfunction because of increased pressure within the carpal tunnel. The causes include overuse, ganglion cyst, synovial proliferation, pregnancy, rheumatoid arthritis, and hypothyroidism.
Nocturnal paresthesia is characteristic.
Phalen's sign, keeping both wrists in a palmar-flexed position may reproduce symptoms. Although cock-up splints have been the classic form of immobilization, they have been shown to be inferior to a simple, neutral splint. Steroid injections of the carpal tunnel may be effective. If EMG shows impaired conduction of the median nerve at the wrist, or the carpal tunnel symptoms do not improve in 6 weeks, or if there is evidence of thenar muscle weakness or atrophy, surgical referral is indicated. Injury resulting from forced flexion of distal tip of a finger.