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bioRxiv2024 September 26

They act on different pathways, which is why they are often used together rather than competing with each other

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 * Phalens test wrist flexion reproduces symptoms * Tinels sign tapping over wrist causes tingling Diagnosis * Mostly clinical * Nerve conduction studies confirm severity Management Conservative (mildmoderate) * 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 Dr

10.1038/s41586-019-1707-0 Nature 25 DongH.QiangZ.ChaiD.PengJ.XiaY.HuR.et al (2020)