FN: Carpal Tunnel Syndrome Flashcards Preview

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Flashcards in FN: Carpal Tunnel Syndrome Deck (16):
1

Anatomy

- Carpal tunnel formed by flexor retinaculum and carpal bones

2

Carpal tunnel contains

- 4 tendons of FDS
- 4 tendons of FDP
- 1 tendon of FPL
- Median Nerve

3

Median N supplies

LLOAF
- abductor pollicis brevis

4

Area not affected

Palmer cutaneous branch travels superficial to flexor retinaculum - spares sensation over thenar area

5

Causes

- F>M
- Primary/secondary

6

Secondary causes

1. Water: pregnancy, hypothyroidism
2. Radial fractures
3. Inflammation: RA, gout
4. Soft tissue swelling: lipomas, acromegaly, amyloidosis
5. Toxic: DM, EtOH

7

Symptoms

- Tingling/pain in thumb, index and middle fingers
- Pain worse at night or after reptitive actions
Relieved by shaking/flicking
Clusiness

8

signs

- reduced sensation over lateral 31/2 fingers
- reduced 2 point touch discrimination: early sign of irreversible damage
- wasting of thenar eminence: late sign of irreversible damage
- Phalens flexing and tinnel's tapping

9

Investigations

- Not usually performed
- Nerve conduction studies
- US

10

Non-surgical Mx

- Mx of underlying cause
- Wrist splints: neutral position, esp. @ night
- Local steroid injections

11

Surgical Mx

Carpal tunnel decompression by division of the flexor retinaculum

12

Complications

- Scar formation: high risk of hypertrophic or kyeloid
- Scar tenderness: up to 40%
- Nerve injury
- Failure to relieve symptoms

13

Nerve injury form surgery

1. Palmar cutaneous branch of the median nerve
2. Motor branch to the thenar muscles

14

Other locations of median nerve entrapment

1. pronator syndrome
2. Anterior interoseous syndrome

15

Pronator syndrome

Entrapement between two heads of pronator

16

Anterior interoseous syndrome

- Compression of the anterior interosseous branch by the deep head of pronator teres
- Muscle weakness only: pronator quadratus, FPL, radial half of FDP

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