Carpal tunnel syndrome Flashcards Preview

My Ortho Upper Limb > Carpal tunnel syndrome > Flashcards

Flashcards in Carpal tunnel syndrome Deck (14):
1

Hx

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

2

look/ inspect

wasting of thenar muscles

3

feel

paraesthesia/ numbness in median nerve distribution in hand

4

movement

nil of note

5

special tests

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

6

other exams

neuro exam of hand: possible reduced sensation over palmar radial surface thumb and index finger with reduction in power of thumb abduction

7

DDx

carpal tunnel syndrome
cervical disc disease
hypothyroidism
MS

8

Why is carpal tunnel syndrome likely?

nocturnal pain in medial nerve distribution in hand and positive Tinel's sign

9

why is cervical disc disease unlikely?

no pain in c spine
normal c spine exam
normal neuro exam upper limb

10

why is hypothyroidism unlikely?

normal TFTs
fully compliant with eltroxin

11

why is MS unlikely?

no symptomatic episodes separated in space and time

12

no investigations required normally but...

x-ray if OA suspected
nerve conduction studies
bloods - fasting glucose Rheumatoid factor
pregnancy test

13

non-op tx

analgesia
physio
refer to ortho

14

op tx

carpal tunnel release
open vs endoscopic