Carpal tunnel syndrome and ankle d/o

Question 1

Carpal tunnel syndrome (CTS)

Answer 1

• Peripheral nerve (median nerve) compression under the flexor retinaculum w/in the carpal tunnel (roof= carpal bones)
• At this point the median nerve is primarily sensory, except the recurrent median nerve
• CTS mostly in females, middle age, 50% of the time is bilateral
• Causes gradual onset of numbness and tingling in the first 3 fingers
• Often starts overnight and is relieved by shaking the hand
• Both flexion and extension (driving) can make worse

Question 2

Causes of CTS and diagnostic tests

Answer 2

• Other causes of this compression can be space-occupying lesion, edema, RA, gout, ect
• Risk factors: over use syndrome, systemic conditions
• PE tests: tinels (tapping on the median nerve to illicit medial nerve irritation and Sx) and phalens (pt holds wrist at full flexion for 30 sec to illicit medial nerve irritation and Sx), both usually positive
• Slight thenar atrophy and decreased sensation of median nerve
• Lab studies: EMG and nerve conduction studies
• Results: they show an increase in the distal median sensory latency time and distal median motor conduction time, also early denervation of thenar muscles

Question 3

Rx of CTS and prognosis

Answer 3

• Conservative Rx: wrist splint, NSAIDs, steroid injection
• Aggressive Rx: surgery
• Early outcome: pain reduction, improvement in sensation and motor function
• Late outcome: improved dexterity/grip strength, prevent further damage

Question 4

Ankle d/o 1

Answer 4

• Bones heal in about 6 wks for adults, 2 wks for newborns
• Ortho reductions: make it worse-> pull on it-> make it better
• Ortho principle: start exam one joint above injury and finish one joint below injury
• Ankle sprains: due to microtears or complete tears of the anterior talofibular ligament (ATFL) and/or the calcaneal fibular ligament (CFL)
• Bunions are due to splaying/separation of first 2 metatarsals

Question 5

Ankle d/o 2

Answer 5

• Flat foot due to problem w/ tibialis posterior (posterior medial ankle pain and weak push off)
• Plantar faciitis: heel pain directly over calcaneal tubercle
• Transcutaneous O2 levels: under 30 means problems w/ healing (>30 OK)
• Testing peripheral diabetic neuropathy: monofilament testing
• Achilles tendon tears: usually in men 30-40, hear a pop
• To test: STAMP (STand And Maintain Plantarflexion)