Carpal Tunnel Syndrome (CTS) GOLD Flashcards

1
Q

What is CTS?

A

peripheral nerve entrapment injury due to compression of the median nerve as it passes through the carpal tunnel.

  • Results in sensory and motor disturbance in the median nerve distribution of the hand.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Etiology

A

Exact etiology unclear

  • Repetitive use
  • RA; inflammation
  • Pregnancy
  • Diabetes
  • Cumulative Trauma Disorder
  • Wrist Sprain or Fracture
  • Hypothyroidism

(Any condition that results in edema, inflammation, tumor or fibrosis): may lead to compression of the median nerve and result in ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Signs and Symptoms

A

Initially presents with sensory changes and paresthesia along the median nerve distribution in the hand

  • (night pain)
  • weakness of the hand; decreased grip strength
  • Muscle atrophy
  • clumsiness
  • decreased wrist mobility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Treatments; Conservative Management

A

Conservative Management:

  • splinting
  • ergonomic measures: assessment of an individual’s occupation, work place, leisure activities, living environment
  • local corticosteroid injections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Treatment for severe cases of CTS?

A

Carpal Tunnel Release: To decompress the median nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What nerve becomes entrapped during CTS?

A

Median Nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the normal tissue pressure within the carpal tunnel?

What can the pressure increase to in CTS?

A

Normal: 2-10 mmHg

CTS: >30 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What Structures form the Carpal Tunnel?

A

(Carpal Bones and Flexor Retinaculum aka Transverse Carpal Ligament)

  • Scaphoid Tuberosity
  • Trapezium
  • The Hook of Hamate
  • Pisiform

Others: MEH
- Volar Radiocarpal Ligament
- Volar Ligamentous Extensions between Carpal Bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What Structures Run Through the Carpal Tunnel?

A

Median Nerve + 9 tendons:
- 4 Flexor Digitorum Profundus Tendons
- 4 Flexor Digitorum Superficialis Tendons
- Flexor Pollicis Longus Tendon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What movements lead to an increase in tissue pressures in the carpal tunnel?

A

Wrist Flexion and Extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What age range is an individual most likely diagnosed with CTS?

A

35-55 y/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which gender is most likely affected?

A

Women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

During muscle atrophy what muscle is most often noted to atrophy first?

A

Abductor Pollicis Brevis

> Then progresses to the thenar muscles <

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What laboratory finding would most likely confirm diagnosis of CTS?

A

Electromyography and Electroneurographic studies can be used diagnose a motor conduction delay along the median nerve within the carpal tunnel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How could MRI be used to diagnose CTS?

A

MRI: Could be used to identify
- Inflammation
- Altered Tendon or Nerve Position
- Thickening of the Tendon Sheath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What provocation testing (special tests) could be used to identify CTS?

A
  • (+) Tinel’s Sign
  • (+) Phalen’s Test
  • (+) Tethered Median Nerve Stress Test
17
Q

What post surgical intervention techniques should be utilized for those who have undergone carpal tunnel release?

A
  • Moist heat with electrical stimulation
  • Iontophoresis
  • Cryotherapy
  • Gentle Massage
  • Desensitizing of the Scar Tissue
  • Tendon Gliding Exercises
  • Active ROM
18
Q

What should a patient who has undergone Carpal Tunnel Release avoid?

A
  • Wrist Flexion
  • Forceful Grasp
19
Q

What recent pharmacological intervention has been used in the diagnosis of CTS?

A

Methylprednisolone injected proximally to the carpal tunnel

20
Q

What is the Tethered Median Nerve Stress Test

A
  • Hyperextending the index finger at the distal interphalangeal joint with the wrist maintained in a supinated position.
21
Q

What time of day does pain typically occur, consistent with CTS?

A

Night Pain

22
Q

Hypo or Hyperthyroidism that is associated with CTS?

A

HYPOthyroidism; Leads to tendons being thickened and swollen. Leads to compression of the median nerve in the carpal tunnel.