Carpal Tunnel Syndrome Flashcards
What is carpal tunnel syndrome (CTS)?
It is defined as a condition in which there is compression of the median nerve in the carpal tunnel of the wrist
What is the most common compression neuropathy of the upper limb?
Carpal Tunnel Syndrome
What is the pathophysiological cause of carpal tunnel syndrome?
The compression is related to either a reduced volume or increased pressure within the carpal tunnel
What twelve risk factors are associated with carpal tunnel syndrome?
Middle Aged, 45 – 64 Years Old
Female Gender
Wrist Fractures
Repetitive Strain Injuries
Rheumatoid Arthritis
Ganglion Cysts
Diabetes Mellitus
Hypothyroidism
Pregnancy
Menopause
Smoking
Obesity
Which condition is most commonly associated with carpal tunnel syndrome?
Rheumatoid Arthritis
What are the five clinical features of carpal tunnel syndrome?
Paraesthesia of Thumb, Index & Middle Finger
Pain of Thumb, Index & Middle Finger
Reduced Grip Strength
Weak Thumb Abduction
Wasting Thenar Eminence
Describe the pain associated with carpal tunnel syndrome
Gradual Onset
Nocturnal
Intermittent
Relief Through Shaking/Flicking Hand
What four investigations are used to diagnose carpal tunnel syndrome?
Phalen’s Test
Tinel’s Test
Electromyography (EMG)
Nerve Conduction Studies
How is the Phalen’s test conducted?
It involves asking individuals to hold their wrist in maximum forced flexion, by pushing the dorsal surfaces of both hands together, for a period of 60 seconds
What is a positive Phalen’s test?
It is indicated by pain or paraesthesia in the median nerve distribution during this manoeuvre
How is the Tinel’s test conducted?
It involves the examiner taping over the patient’s carpal tunnel with their finger
What is a positive Tinel’s test?
It is indicated by pain or paraesthesia in the median nerve distribution during this manoeuvre
What is electromyography (EMG)?
It measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle
What electromyography result indicates carpal tunnel syndrome?
Prolonged action potentials in both sensory and motor nerve axons
What are nerve conduction studies?
They measure how fast an electrical impulse is transmitted through the nerve
What nerve conduction study result indicates carpal tunnel syndrome?
Reduced median nerve conduction velocity
When is conservative management used to treat carpal tunnel syndrome?
It is the first line management option used to treat mild to moderate disease
How long should conservative management of carpal tunnel syndrome be trialled for before surgical management is considered?
6 weeks
What are the two conservative management options used to manage carpal tunnel syndrome?
Wrist Rest
Nocturnal Wrist Splinting
When is pharmacological management used to treat carpal tunnel syndrome?
It is the second line management option used to treat mild to moderate disease
What is the pharmacological management option of carpal tunnel syndrome?
Corticosteroid Injections
How are corticostreoid injections used to treat carpal tunnel syndrome?
They can be used to provide symptomatic relief for a period of four weeks
When is surgical management used to treat carpal tunnel syndrome?
It is used to treat severe disease, or when non-surgical management options are deemed ineffective
What is the surgical management option of carpal tunnel syndrome?
Flexor Retinaculum Division
What is flexor retinaculum division?
It involves an incision to the flexor retinaculum, which is the roof of the carpal tunnel, in order to relieve pressure on the median nerve
