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4/3: Elderly/Neuro Y3/4 - Neuro and Stroke [12] > [11] Carpal Tunnel Syndrome > Flashcards

[11] Carpal Tunnel Syndrome Flashcards

1
Q

What is carpal tunnel syndrome?

A

A collection of symptoms and signs caused by compression of the median nerve in the carpal tunnel

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2
Q

What is the carpal tunnel?

A

An anatomical compartment at the base of the palm

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3
Q

What forms the postero-lateral boundary of the carpal tunnel?

A

Scaphoid and trapezium

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4
Q

What forms the postero-medial boundary of the carpal tunnel?

A

Hook of the hamate and the pisiform

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5
Q

What forms the anterior boundary of the carpal tunnel?

A

The flexor retinaculum

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6
Q

What is the contents of the carpal tunnel?

A
  • 9 flexor tendons in synovial sheaths

- Median nerve

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7
Q

What are the 9 flexor tendons in the carpal tunnel?

A
  • 4 of flexor digitorum profundus
  • 4 of flexor digitorum superficialis
  • Flexor pollicis longus
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8
Q

What happens to the median nerve before entering the carpal tunnel?

A

It gives of the palmar cutaneous branch

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9
Q

What is the role of the palmar cutaneous branch of the median nerve?

A

It provides sensation to the lateral palm of the hand

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10
Q

What is true of the palmar cutaneous branch in carpal tunnel syndrome?

A

It does not travel through the carpal tunnel and so there is often sparing of the lateral palm in carpal tunnel syndrome

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11
Q

Once it has passed through the carpal tunnel what branches are given off by the median nerve?

A
  • Recurrent motor branch

- Palmar digital nerves

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12
Q

What is the role of the recurrent motor branch of the median nerve?

A

Supplies the thenar muscle group

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13
Q

What is the role of the palmar digital nerve of the median nerve?

A
  • Sensory innervation to the palmar skin and dorsal nail beds of the lateral 3and 1/2 digits
  • Motor innervation of the lateral 2 lumbricals
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14
Q

What can lead to compression of the median nerve within the carpal tunnel?

A
  • Decrease in size of the tunnel
  • Increase in size of the contents
  • Both
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15
Q

Why does increased tunnel pressure lead to compression of the median nerve?

A

The boundaries of the carpal tunnel are rigid

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16
Q

What are the risk factors for carpal tunnel syndrome?

A
  • Obesity
  • Repetitive wrist work
  • Pregnancy
  • Genetics
  • Rheumatoid arthritis
17
Q

What repetitive wrist work can lead to increased risk of carpal tunnel syndrome?

A
  • Computer work
  • Work with vibrating tools
  • Work that requires a strong grip
18
Q

Wha tis carpal tunnel syndrome characterised by?

A

Tingling, numbness or pain in the distribution of the affected median nerve branches

19
Q

What are the areas affected by carpal tunnel syndrome?

A
  • Thumb
  • Index and middles fingers
  • Medial half of the ring finger on the palmar aspect
20
Q

When is carpal tunnel syndrome pain often worse?

A

At night

21
Q

How can symptoms of carpal tunnel syndrome develop?

A

They can become more persistent and radiate to the forearm, elbow, arm and shoulder

22
Q

What clinical sign may be present in later carpal tunnel syndrome?

A

Wasting of the thenar muscles

23
Q

How can carpal tunnel syndrome be clinically identified?

A
  • Positive Phalen’s test
  • Positive Tinel’s sign
  • Positive carpal tunnel compression test
24
Q

What is a positive Phalen’s test?

A

Flexing the wrist for 60 seconds causes pain or paraesthesia in the median nerve distribution

25
Q

What is a positive Tinel’s sign?

A

Tapping lightly over the median nerve at the wrist causes distal paraesthesia in the median nerve distribution

26
Q

What is a positive carpal tunnel compression test?

A

Pressure over the proximal edge of the carpal ligament (proximal wrist crease) causes paraesthesia to develop or increase in median nerve distribution

27
Q

When are investigations for carpal tunnel syndrome needed?

A

When there is diagnostic doubt or before surgery

28
Q

What investigations can be used for carpal tunnel syndrome?

A

Electroneurography (ENG)

29
Q

What happens in ENG for carpal tunnel syndrome?

A

The median nerve is stimulated proximal to the carpal ligament and compound muscle action potential is picked up over the thenar eminence

30
Q

What are the differentials for carpal tunnel syndrome?

A
  • Other median nerve compression
  • Cervical radiculopathy
  • Thoracic outlet syndrome
  • Tendonitis
  • Ulner neuropathy
  • MS
31
Q

Over what period may carpal tunnel syndrome spontaneously resolve?

A

6 months

32
Q

When is spontaneous resolution of carpal tunnel syndrome most likely?

A
  • Under 30’s
  • Unilateral
  • Short duration
  • In women who were precipitated by pregnancy
33
Q

What conservative management can be used for carpal tunnel syndrome?

A
  • Minimise exacerbating activities

- Splinting

34
Q

When should referral be made for patients with carpal tunnel syndrome?

A
  • Diagnosis is uncertain
  • Treatments have failed after 3 months
  • Severe, persisting symptoms, especially if thumb weakness
35
Q

What may treatment for carpal tunnel syndrome involve?

A
  • Local corticosteroid injections
  • Surgical treatment
  • Physiotherapy
36
Q

What does surgical treatment for carpal tunnel syndrome involve?

A

Release of the nerve by cutting the transverse carpal ligament

37
Q

What are the disadvantages of surgical treatment of carpal tunnel syndrome?

A
  • Surgery related pain
  • Hand weakness
  • Complications of surgery
38
Q

What physiotherapy techniques can be used in carpal tunnel syndrome?

A
  • Stretching of the wrist to improve blood flow

- Exercises to improve strength and flexibility

4/3: Elderly/Neuro Y3/4 - Neuro and Stroke [12] (33 decks)

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