Carpel tunnel syndrome profoma

Question 1

Epidemiology of carpal tunnel syndrome

Answer 1

• Most common entrapment neuropathy
• Very common in middle-aged & elderly women

Question 2

Pathophysiology of carpal tunnel syndrome

Answer 2

Results from compression of median nerve, as it passes through the carpal tunnel.
- The carpal tunnel is a space that is formed by transverse carpal ligament & carpal bones

Question 3

Aetiology of carpel tunnel syndrome

Answer 3

Idiopathic
- Diabetes
- hyperthyroidism
- RA- rheumatoid nodules, vasculitic lesions & MCP joint arthritis can lead to carpal tunnel.
- Pregnancy
- Acromegaly
- Trauma - wrist fracture- can cause swelling, narrowing the carpal tunnel.
- Obesity

Question 4

Presentation of carpal tunnel syndrome

Answer 4

Pain and/or paraesthesia in the thumb, index finger, middle finger & lateral half of ring finger.
- i.e where median nerve enervates (palmar aspect!)

NOTE: view diagram on notes

• Patient shakes their hand to obtain relief, classically at night.
• Worse at night*- often relieved by hanging hand over side of bed.

Motor:
- Weakness of thumb abduction (abductor pollicis brevis)
- Weak opposition (opponens pollicis brevis)
- Thenar muscle wasting - severe cases.
- Low grip strength & pinch grip

Question 5

Investigations for carpel tunnel syndrome

Answer 5

• Tinel’s sign - where you tap the wrist at the carpal tunnel. Positive if someone feels numbness & parasthesia in the thumb, index, middle & lateral half of ring fingers.
• Phalen’s sign- involves flexing both wrists and then holding for 30 seconds. Positive = parasthesia.

Motor signs- LOAF
- Lateral- 1st & 2nd lumbricals
- Opponens pollicis- ask patient to touch thumb to little finger & resists attempts to separate the 2
- Abductor pollici brevis- w/ dorsum of hand flat on table ask patient to abduct thumb & resist addiction force
- Flexor pollicis brevis- flexes thumb at MCP joint

Question 6

Management for carrell tunnel syndrome

Answer 6

6-week trial of conservative treatmentsif symptoms are mild-moderate:
- Corticosteroid injection
- Wrist splints at night
- Rest
- Diuretics

If symptoms severe or symptoms persist w/ conservative management:
- Surgical decompression (flexor retinaculumdivision)

Question 7

Prognosis for carpel tunnel syndrome

Answer 7

• Surgery high success-over 90%
• 70% chance of improvement wearing splints after several weeks to months.
• Success rate of between 70% up to 6 months post corticosteroid injection