FN: Carpal Tunnel Syndrome Flashcards
1
Q
Anatomy
A
- Carpal tunnel formed by flexor retinaculum and carpal bones
2
Q
Carpal tunnel contains
A
- 4 tendons of FDS
- 4 tendons of FDP
- 1 tendon of FPL
- Median Nerve
3
Q
Median N supplies
A
LLOAF
- abductor pollicis brevis
4
Q
Area not affected
A
Palmer cutaneous branch travels superficial to flexor retinaculum - spares sensation over thenar area
5
Q
Causes
A
- F>M
- Primary/secondary
6
Q
Secondary causes
A
- Water: pregnancy, hypothyroidism
- Radial fractures
- Inflammation: RA, gout
- Soft tissue swelling: lipomas, acromegaly, amyloidosis
- Toxic: DM, EtOH
7
Q
Symptoms
A
- Tingling/pain in thumb, index and middle fingers
- Pain worse at night or after reptitive actions
Relieved by shaking/flicking
Clusiness
8
Q
signs
A
- reduced sensation over lateral 31/2 fingers
- reduced 2 point touch discrimination: early sign of irreversible damage
- wasting of thenar eminence: late sign of irreversible damage
- Phalens flexing and tinnel’s tapping
9
Q
Investigations
A
- Not usually performed
- Nerve conduction studies
- US
10
Q
Non-surgical Mx
A
- Mx of underlying cause
- Wrist splints: neutral position, esp. @ night
- Local steroid injections
11
Q
Surgical Mx
A
Carpal tunnel decompression by division of the flexor retinaculum
12
Q
Complications
A
- Scar formation: high risk of hypertrophic or kyeloid
- Scar tenderness: up to 40%
- Nerve injury
- Failure to relieve symptoms
13
Q
Nerve injury form surgery
A
- Palmar cutaneous branch of the median nerve
2. Motor branch to the thenar muscles
14
Q
Other locations of median nerve entrapment
A
- pronator syndrome
2. Anterior interoseous syndrome
15
Q
Pronator syndrome
A
Entrapement between two heads of pronator
