Carpal Tunnel Syndrome and Restless leg syndrome

Question 1

What is?
An entrapment neuropathy caused by compression of the median nerve between the carpal ligament and other structures within the carpal tunnel.
-Can be caused by repetitive wrist activities.
-Commonly seen during pregnancy and in patients with diabetes mellitus or
rheumatoid arthritis.

Answer 1

Carpal tunnel syndrome

Question 2

Clinical presentation of what?
(1) Pain, burning, and tingling in the distribution of the median nerve.
(a) Median nerve innervates thumb, pointer, middle and half of the ring finger
(2) Initially, most bothersome during sleep.
(3) Late in the syndrome weakness or atrophy of the thenar eminence may occur

Answer 2

Carpal tunnel syndrome

Question 3

Carpal tunnel syndrome diagnosis
(1) ______sign exacerbates neuropathic symptoms
(2) Diagnosed with ______ and nerve conduction studies.

Answer 3

Tinel or phalen’s sign
ultrasound

Question 4

Carpal tunnel syndrome treatment
Patient should modify their hand activities and the affected wrist should be splinted in
neutral position for how long?.

Answer 4

up to 3 months

Question 5

Carpal tunnel syndrome treatment
What meds can you use to help decrease inflammation and lesson pain?

Answer 5

Oral or injected steroids or NSAIDS

Question 6

Carpal tunnel syndrome treatment
Refer a patient when? (2)

Answer 6

If symptoms persist longer than 3 months despite treatment including use of the wrist splint.

If thenar muscle develops weakness or atrophy .

Question 7

Treatment for carpal tunnel syndrome is directed toward relief of pressure on what nerve?

Answer 7

median nerve

Question 8

definitive treatment for Carpal tunnel system

Answer 8

Carpal tunnel release surgery

Question 9

What is an uncomfortable “creeping, crawling” sensation or “pins and needles feeling” in the limbs, especially in the legs.

Answer 9

restless leg syndrome (RLS)

Question 10

RLS tends to occur during periods of _____, particularly the _____

Answer 10

inactivity
evenings

Question 11

Hallmark symptom for what?
unpleasant or uncomfortable urge to move legs(sometimes arms) that is transiently relieved with movement

Answer 11

RLS

Question 12

Sensations for RLS are described ether
Deep or Superficial?

Answer 12

deep

Question 13

What medications can be exacerbating factors for RLS?

Answer 13

Antihistamines, Dopamine, Antidepressants like SSRI’s and SNRI’s

Question 14

Differential diagnosis’s for RLS

Answer 14

Volitional movements
Akathisia: Intense desire to move
Nocturnal leg cramps

Question 15

What are common disorganized spasms of muscles that is associated with palpable muscle contraction?

Answer 15

Nocturnal leg cramps

Question 16

What is: Foot tapping, bouncing, leg rocking that usually lacks circadian rhythm pattern and not associated with “urge”

Answer 16

Volitional movements

Question 17

Clinical diagnosis for what and should be suspected in patients who have complaint of urge to move legs when lying in bed or sitting down?

Answer 17

RLS….

Question 18

What laboratory study should consider for RLS?

Answer 18

Iron
Serum ferritin <45 to 50mcg/L indicates low iron etiology

Question 19

What would be some Non-pharacologic treatments for RLS

Answer 19

1) Avoidance of aggravating drugs and substances like caffeine
2) Increase exercise
3) Leg massage

Question 20

Treatment of RLS
What medication would you start your pt on if the patient’s serum ferritin level is <75mcg/L

Answer 20

Ferrous sulfate 325mg TID for 3-6 months