2-Carpal Tunnel Syndrome
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Transcript 2-Carpal Tunnel Syndrome
Carpal Tunnel Syndrome
Hand/Finger/Wrist Issues
Presentation:
A 64-year-old, right-handed, retired woman
presents with:
intermittent numbness, tingling, and burning pain
Location: The three radial digits of both hands
Duration: Had these symptoms for three months
History: These symptoms awaken her several times each
night.
On examination:
She has no atrophy of the thenar muscles.
Sensation to light touch is intact.
How should she be evaluated and treated?
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Scope of the problem
2.7 million office visits
Differential diagnosis:
Entrapments of the nervesCarpal tunnel syndrome,
Entrapment of the ulnar nerve
Cervical radiculopathy
Tendon disorders,
Overuse of muscles,
Nonspecific pain syndromes
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CT Anatomy
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CTS Data
F: 3%, M:2%, Average age: 55 yrs
Elevated pressure in the carpal tunnel
Results in ischemia of the median nerve
Causes impaired nerve conduction and attendant
paresthesia and pain
Related Conditions:
Pregnancy
Inflammatory arthritis- RA
Colles’ fracture
Amyloidosis
Hypothyroidism
Diabetes mellitus 6%
Acromegaly
Use of corticosteroids and estrogens
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CTS: Occupational
Repetitive activities of the hand and wrist
particularly with a combination of forceful and
repetitive activities:
Food processing
Manufacturing
Logging
Construction work
Data entry
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History
Pain, tingling, burning, numbness, or some
combination of these symptoms on the palmar
aspect of the thumb, index finger, middle
finger, and radial half of the ring finger
No such symptoms affect the fifth finger
Nocturnal symptoms reported (51-77%)
“Flick Sign”: Shake the symptomatic hand or
hands when symptoms are at their worst gives
relief
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Assessment
Late signs:
Loss of two-point discrimination in the median
nerve distribution
Thenar atrophy
Phalen’s maneuver: Flexion of the wrist for 60
seconds elicits pain or paresthesia in the
median-nerve distribution (40-80%)
Tinel’s sign: Present if tapping lightly over the
volar surface of the wrist causes radiating
paresthesia in the digits innervated by the
median nerve (67-87%)
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Therapies
Treat associated conditions
Wrist splint alleviates symptoms (80%);
maintain the wrist in neutral posture rather
than in extension
Medications- ?NSAIDs, B6
Prednisone helps (10mg/day)
Local Corticosteroid Injection (75% relief)
symptoms recur within 1 yr (Poor prognosis:
constant numbness, impaired sensibility, and weakness or
thenar muscular atrophy) Limit injections to 3/yr
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?Surgery
Carpal-tunnel–release surgery (on demand)
Indications: constant numbness, symptoms
for more than one year, loss of sensibility, and
thenar muscular atrophy or weakness
Direct or endoscopic carpal ligament release
Endoscopic –increased risk of median nerve injury/
benefit earlier return to work
“mini”-open release
70-90% success in pain relief
Electro-diagnostic studies help to choose
patients
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Surgical Scars
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?Alternative Therapies
“not been evaluated”
yoga-based stretching, strengthening, and
relaxation
chiropractic therapy
minimize forceful hand and wrist activities
acupuncture, dietary supplements
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U/S imaging
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