Carpal tunnel syndrome Flashcards
Hx
34 yr old F, 6 month hx pain in l hand, pain keeps her awake at night, not relieved by simple analgesia, pins and needles, raised BMI, Eltroxin, TFT normal
look/ inspect
wasting of thenar muscles
feel
paraesthesia/ numbness in median nerve distribution in hand
movement
nil of note
special tests
Phalen’s test: wrist volar flexion for 60 sec produces symptoms
Tinels test: provocative tests performed by tapping the median nerve over the volar carpal tunnel
other exams
neuro exam of hand: possible reduced sensation over palmar radial surface thumb and index finger with reduction in power of thumb abduction
DDx
carpal tunnel syndrome
cervical disc disease
hypothyroidism
MS
Why is carpal tunnel syndrome likely?
nocturnal pain in medial nerve distribution in hand and positive Tinel’s sign
why is cervical disc disease unlikely?
no pain in c spine
normal c spine exam
normal neuro exam upper limb
why is hypothyroidism unlikely?
normal TFTs
fully compliant with eltroxin
why is MS unlikely?
no symptomatic episodes separated in space and time
no investigations required normally but…
x-ray if OA suspected
nerve conduction studies
bloods - fasting glucose Rheumatoid factor
pregnancy test
non-op tx
analgesia
physio
refer to ortho
op tx
carpal tunnel release
open vs endoscopic
