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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

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Carpal Tunnel Syndrome

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  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

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