Flashcards in Carpal tunnel syndrome Deck (14):
34 yr old F, 6 month hx pain in l hand, pain keeps her awake at night, not relieved by simple analgesia, pins and needles, raised BMI, Eltroxin, TFT normal
wasting of thenar muscles
paraesthesia/ numbness in median nerve distribution in hand
nil of note
Phalen's test: wrist volar flexion for 60 sec produces symptoms
Tinels test: provocative tests performed by tapping the median nerve over the volar carpal tunnel
neuro exam of hand: possible reduced sensation over palmar radial surface thumb and index finger with reduction in power of thumb abduction
carpal tunnel syndrome
cervical disc disease
Why is carpal tunnel syndrome likely?
nocturnal pain in medial nerve distribution in hand and positive Tinel's sign
why is cervical disc disease unlikely?
no pain in c spine
normal c spine exam
normal neuro exam upper limb
why is hypothyroidism unlikely?
fully compliant with eltroxin
why is MS unlikely?
no symptomatic episodes separated in space and time
no investigations required normally but...
x-ray if OA suspected
nerve conduction studies
bloods - fasting glucose Rheumatoid factor
refer to ortho