Carpal Tunnel Syndrome Flashcards
Carpal tunnel syndrome is caused by entrapment of which nerve?
median
The median nerve becomes entrapped between what?
The carpal ligament and other structures within the carpal tunnel
The contents of the tunnel can be compressed by what type of things?
- synovitis of the tendon sheaths or carpal joints
- recent or malhealed fractures
- tumors
- tissue inflammation
- congenital syndromes
In what type of patients is carpal tunnel common?
- pregnant women due to fluid retention
- individuals with a history of repetitive hand use
- in individuals following wrist injury
Carpal tunnel syndrome can also be a feature of many systemic diseases such as what?
- RA
- myxedema
- amyloidosis
- sarcoidosis
- leukemia
- acromegaly
- hyperparathyroidism
What are the initial signs and symptoms of carpal tunnel syndrome?
Pain, burning, and tingling in the distribution of the median nerve (the palmar surfaces of the thumb, the index and long fingers)
What is pain exacerbated by?
manual activity, particularly by extremes of volar flexion or dorsiflexion of the wrist
What time of day is carpal tunnel syndrome most bothersome?
at night
What sign is usually found positive in carpal tunnel syndrome patients?
Tinel of Phalen sign
What is Tinel sign?
tingling or shock-like pain on volar wrist percussion
What is Phalen sign?
pain or paresthesia in the distribution of the median nerve when the patient flexes both wrists to 90 degrees for 60 seconds
What other test can be performed in order to diagnose carpal tunnel syndrome?
The carpal tunnel compression test, in which direct application of pressure over the carpal tunnel elicits numbness and tingling
What are some signs that appear later than sensory disturbances as compression of the nerve worsens?
muscle weakness or atrophy, especially of the thenar eminence
What imaging modality can demonstrate flattening of the median nerve beneath the flexor retinaculum?
ultrasound
What is the sensitivity of unltrasound for carpal tunnel?
54-98%
What special tests can show evidence of sensory conduction delay before motor delay?
electromyography and nerve conduction studies
When left-sided what can carpal tunnel be confused with?
angina pectoris
What is carpal tunnel syndrome treatment directed towards?
relief of pressure on the median nerve
Patients in which carpal tunnel is suspected should have the affected wrist splinted in the neutral position for how long?
3 months
When can a patients undergo carpal tunnel release surgery?
When they have had a positive electrodiagnostic test, at least moderate symptoms, high clinical probability, unsuccessful nonoperative treatment, and symptoms lasting longer than 12 months
When should you refer a patient?
- if symptoms persist greater than 3 months despite conservative treatment, including the use of wrist splints
- if thenar muscle weakness or atrophy appears
