Flashcards in Wrist & Hand: Carpal Tunnel Syndrome Deck (18)
what is carpal tunnel syndrome?
compression of the median nerve within the carpal tunnel of the wrist due to raised pressure in the compartment
what are the symptoms of carpal tunnel syndrome?
pain, numbness and paresthesia of the lateral 3 1/2 digits
is carpal tunnel syndrome more common in women or men?
what is the peak age of incidence for carpal tunnel syndrome?
what are the risk factors for carpal tunnel syndrome?
previous wrist injury
occupations involving repetitive hand or wrist movements
what other conditions is carpal tunnel syndrome associated with?
diabetes mellitus, RA and hypothyroidism
what are the clinical features of carpal tunnel syndrome?
pain, numbness and/or paraesthesia throughout median nerve distribution
palm is often spared
what is the palm often spared in carpal tunnel syndrome?
palmar cutaneous branch of the median nerve branching proximal to the flexor retinaculum and passing over the carpal tunnel
when is the pain typically worse in carpal tunnel syndrome?
worse during night and symptoms can often be temporarily relieved by hanging the affected arm over the side of the bed or by shaking back and fourth
what is seen on examination of carpal tunnel syndrome?
often no visible findings during early stages
symptoms can be reproduced by either percussing over the median nerve (Tinel's Test) or holding the wrist in full flexion for 1 minute (Phalen's Test)
what can often be seen in the later stages of carpal tunnel syndrome?
weakness of thumb abduction due to denervation atrophy of the thenar muscles and/or wasting of the thenar eminence
DDx for carpal tunnel syndrome?
cervical radiculopathy - likely to have element of neck pain or symptoms involving the arm
pronator teres syndrome - symptoms will extend to proximal forearm and sensation to palm will be reduced
flexor carpi radialis tenosynovitis - tenderness at the base of the thumb
how is carpal tunnel syndrome investigated?
clinical diagnosis - evident pathology in most cases from Hx and examination
uncertain cases - nerve conduction studies may be useful to confirm median nerve damage (normal median nerve conduction does not rule out CTS)
how is carpal tunnel syndrome managed?
conservatively - wrist splinting - prevents wrist flexion and hols wrist as to not exacerbate the tingling pain
physiotherapy and various exercises
corticosteroid injections can be trialled
outline corticosteroid treatment in carpal tunnel syndrome
can be trialled
administered directly into carpal tunnel to reduce swelling and in turn reduce the symptoms
NSAIDs may be used in an attempt to further reduce swelling - limited evidence in routine use
outline the surgical management of carpal tunnel syndrome
severely limiting cases where previous treatment has failed
carpal tunnel release surgery - decompress the carpal tunnel involving cutting through the flexor retinaculum which release the pressure on the median nerve - local anaesthetic and done as a day case
90% report improved symptoms
what are the complications of carpal tunnel surgery?
persistent CTS symtoms