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10.1038/ng.3359 137 LiuK.LiG.GuoW.ZhangJ

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Common causes / risk factors * Repetitive hand use (typing, manual work) * Pregnancy * Diabetes * Hypothyroidism * Rheumatoid arthritis * Obesity Symptoms (classic pattern) * Numbness & tingling in: * Thumb, index, middle, and half of ring finger * Pain (may radiate to forearm) * Weak grip * Thenar muscle wasting (late sign) * Symptoms worse at night Clinical tests * Phalen’s test → wrist flexion reproduces symptoms * Tinel’s sign → tapping over wrist causes tingling Diagnosis * Mostly clinical * Nerve conduction studies confirm severity Management Conservative (mild–moderate) * Wrist splint (especially at night) * Activity modification * NSAIDs * Steroid injections Definitive * Surgical decompression (release of flexor retinaculum) * Permanent nerve damage if untreated “LOAF muscles” affected by median nerve * Lumbricals (1st & 2nd) * Opponens pollicis * Abductor pollicis brevis * Flexor pollicis brevis