carpal tunnel syndrome Flashcards
what is carpal tunnel syndrome?
a condition involving compression of the median nerve within the carpal tunnel of the wrist due to raised pressure within this compartment
what are the risk factors for carpal tunnel?
- female
- increasing age
- pregnancy
- obesity
- previous injury to the wrist
what conditions is carpal tunnel associated with?
hypothyroidism
DM
RA
what are the clinical features of carpal tunnel?
- pain
- numbness
- paraesthia
in the lateral 3 1/2 digits
palm is often spared due to palmar cutaneous branch of median nerve passing over carpal tunnel
symptoms are worse at night, may be relieved by hanging arm over side of bed or shaking it
in later stages of CTS, may be weakness of thumb abduction due to denervation atrophy of thenar muscles, and/ or wasting of the thenar eminence
what tests can be done to produce sensory symptoms ?
percussing over the median nerve (Tinel’s Test) or holding the wrist in full flexion for one minute (Phalen’s Test).
what are the differentials for CTS?
- cervical radiculopathy (C6 nerve root involvement may produce pain or paraesthesia in a similar distrubution)
- pronator teres syndrome (compresses median nerve)
- flexor carpi radials tenosynovitis
what investigations are done into CTS?
its a clinical diagnosis
if uncertain, can do nerve conduction studies
how is CTS managed conservatively?
- wrist splint
- corticosteroid injections
how can CTS be managed surgically?
in severely limiting cases
CT release surgery decompresses carpal tunnel by cutting through flexor retinaculum
what are the complications of CT surgery?
- persistent CTS symptoms
- infection
- scar
- nerve damage
- trigger thumb
what are complications of long term untreated CTS?
permanent neurological impairment that will not improve with surgery
