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compression of median nerve in carpal tunnel

History
pain / pins / needles in thumb, index and middle finger
may unusally ascend proximally
pt shakes hand to obtain relief esp at night

Exam
weak thumb abduction (abductor pollicis brevis)
wasting of thenar eminance (NOT hypothenar)
Tinel's sign - tapping causes paraesthesia
Phalen's sign - flexion of wrist causes Sx

Causes
Idiopathic
Pregnancy
Oedema (eg heart failure)
Lunate fracture
RA

Ix
Electrophysiology - motor and sensory prolongation of action potential

Rx
Corticosteroid injection
wrist splints at night
surgical decompression (flexor retinaculum division)