Week 3 Carpal Tunnel Syndrome Flashcards
What is the presentation of carpal tunnel syndrome?
- gradual onset of numbness and tingling in the fingers
- flexion and extension of the wrist makes it worse
- using a heavy book bag can retract the shoulders can produce symptoms, pressing on brachial plexus
What are risk factors for carpel tunnel syndrome?
- space occupying lesions: fracture, infection, local edema, ganglion, lipoma, foreign body, tenosynovitis
- systemic conditions: obesity, diabets, arthritis, thyroid dysfunction
- over use syndromes: postural habits, constricting jewelry
Who typically gets carpal tunnel syndrome?
-most often with patients over 30 years old, more so in females
What are some physical exam findings in carpel tunnel syndrome?
- decrease sensation of median nerve distribution
- slight thenar muscle atrophy
- positive tinel’s sign
- positive phalen’s test
What is Tinel’s sign?
-percussion of a peripheral nerve, in the case of CTS, tap over velar center of wrist, patient will feel tingling or electric shock radiating to above fingers–>positive Tinel’s sign
What is Phalen’s test?
To test for CTS
- patient’s wrist in in full flexion for 30 sec. Place dorsum of hands together upside down in front of body and hold.
- if patient experiences numbness or tingling, to thumb, index, or middle fingers, they have a positive Phalen’s test
What are diagnostic tests that can be done for carpal tunnel syndrome?
- electromyogram and nerve conduction studies best
- xray and MRI don’t show much
What are treatment options for carpal tunnel syndrome?
- wrist splint
- NSAID
- steroid injection into carpal canal
- surgery: decompression of the median nerve at the wrist
What are the anticipated outcomes of surgical treatment of carpal tunnel syndrome?
Early
-pain reduction, improvement in sensation and/or motor function
-reduction of paresthesias
Later
-improved dexterity and grip strength
-prevention of further deterioration in nerve function
