1 / 14

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

kendra
Télécharger la présentation

Carpal Tunnel Syndrome

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Carpal Tunnel Syndrome Hand/Finger/Wrist Issues

  2. 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?

  3. Scope of the problem • 2.7 million office visits • Differential diagnosis: • Entrapments of the nerves- • Carpal tunnel syndrome, • Entrapment of the ulnar nerve • Cervical radiculopathy • Tendon disorders, • Overuse of muscles, • Nonspecific pain syndromes

  4. CT Anatomy

  5. 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

  6. 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

  7. 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

  8. 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%)

  9. 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

  10. ?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

  11. Surgical Scars

  12. ?Alternative Therapies • “not been evaluated” • yoga-based stretching, strengthening, and relaxation • chiropractic therapy • minimize forceful hand and wrist activities • acupuncture, dietary supplements

  13. U/S imaging

More Related