What is the relationship between diabetes and CTS?
CTS commonly (20%) occurs in patients with diabetes. Patients present with numbness in the median nerve distribution. Nocturnal paresthesias, hand pain, and pain radiating to the elbow or shoulder (Valleix phenomenon) can also occur. Tinel’s and Phalen’s signs as well as Durkan’s pressure test may be positive. Thenar atrophy is a late sign and indicates muscle denervation. The neuropathy may be from extrinsic compression or due to microvascular disease causing vasa nervorum ischemia. Treatment includes splints, NSAIDs, local steroid injections into the carpal tunnel (relapse risk in diabetics with CTS higher than in nondiabetics), and surgical decompression. See Chapter 64 (Entrapment Neuropathies) for additional details on CTS.
