Clinical Care- Carpal Tunnel Syndrome

Question 1

what is the term for a focal or sensory deficit that is in a territory of an individual peripheral nerve

Answer 1

mononeuropathies

Question 2

what is entrapment neuropathy?

Answer 2

when an individual nerve is injured along its course by being compressed, angulated, ESPECIALLY at a point where it passes through a narrow space.

Question 3

what is an entrapment neuropathy caused by compression of the median nerve between the carpal ligament and other structures within the carpal tunnel?

Answer 3

carpal tunnel syndrome

Question 4

when can carpal tunnel be seen (what type of patients?)

Answer 4

people who need to do repetitive wrist activities

commonly seen during pregnancy and in patients with diabetes mellitus or rheumatoid arthritis

Question 5

Carpal tunnel syndrome presentation

Answer 5

(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

Question 6

Carpal tunnel syndrome diagnosis

Answer 6

(1) Tinel or phalen’s sign exacerbates neuropathic symptoms

(2) Diagnosed with ultrasound and nerve conduction studies.

Question 7

Carpal tunnel syndrome treatment

Answer 7

(1) Patient should modify their hand activities and the affected wrist should be splinted in neutral position for up to 3 months.
(2) Oral or injected steroids or NSAIDS
(3) REFER if symptoms persist more than 3 months despite conservative treatment OR if thenar muscle (e.g., abductor pollicis brevis) weakness or atrophy develops.

Question 8

what is treatment directed toward when treating carpal tunnel syndrome?

Answer 8

treatment is directed toward relief of pressure on the median nerve