Name
CARPAL TUNNEL SYNDROME
DESCRIPTION
DETAIL
CAUSES : - SECONDARY TO EXCESSIVE USE OF WRIST - TENOSYNOVITIS WITH ARTHRITIS - LOCAL INFILTRATION BY THICKENING OF CONNECTIVE TISSUE AS IN ACROMEGALY OR BY DEPOSITS IN AMYLOIDOSIS OR BY ONE OF MUCOPOLYSACCHARIDOSES - HYPOTHYROIDISM - DIABETES MALLITUS β’ Disorders affecting the musculoskeletal system in the region of the wrist including trauma or Collesβ fracture, degenerative joint disease, rheumatoid arthritis, ganglion cyst, scleroderma β’ Other miscellaneous causes include acromegaly, lupus erythematosus, leukemia, pyogenic infections, sarcoidosis, primary amyloidosis and Paget disease β’ Hyperparathyroidism, hypocalcemia -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ Cervical spondylosis β’ Generalized peripheral neuropathy β’ Brachial plexus lesion* BLOOD SUGAR * THYROID FUNCTION TEST . Electromyography : Will be abnormal in more than 85% of cases . Prolonged distal latency of the median motor nerves may be seen . The most sensitive indicator is the median sensory distal latency which is prolonged. Furthermore the sensory nerve action potential may be reduced or unobtainable. . Stimulation of the ulnar nerve should be done as well to exclude generalized polyneuropathy IMAGING : . Special x-ray views of the carpal tunnel may be obtained. These are of limited usefulness unless heterotopic calcification can be identified. . Magnetic resonance (MR) neurography may be used to confirm compression of the median nerve in the carpal tunnel and to assess the success of surgical decompression DIAGNOSTIC PROCEDURES: . Tinels sign - tapping of the wrist proximal to the carpal tunnel may produce electric sensation perceived by the patient, a sign of nerve compression . Phalens sign - holding the wrist flexed for 60 seconds may precipitate the paresthesias experienced by the patient . A blood pressure tourniquet to cut off circulation to the arm may precipitate symptoms promptly
TYPENOTES
RISK FACTORS: Repetitive flexion and extension of the wrist may infl uence the development of carpal tunnel syndrome. Occupation as a seamstress or computer operator may aggravate carpal tunnel syndrome.GENERAL MEASURES : β’ Splinting of the wrist in extension may provide significant relief of symptoms. Prolonged use of splinting if possible may allow some symptoms to resolve. β’ Injection of the carpal tunnel with hydrocortisone (Medrol 40 mg/mL). 1 mL + 1% lidocaine (1 mL) may provide significant temporary relief. This is particularly useful during pregnancy. SURGICAL MEASURES: β’ Surgical decompression of the carpal tunnel by dividing the transverse carpal ligament completely provides almost complete relief of symptoms in over 95% of patients β’ Surgical decompression is usually done as an outpatient under local anesthesia β’ Healing of the incision generally takes two weeks; an additional two weeks of recuperation may be required before the hand can be fully utilized for tasks requiring strength β’ Recent randomized, controlled studies indicate that surgery is more effective than splinting at 18 months DRUG(S) OF CHOICE : Nonsteroidal antiinflammatory agents such as ibuprofen 400 mg three or four times a day or naproxen sodium 500 mg twice a day will provide signifi cant relief of symptoms in many patients PATIENT MONITORING : β’ Patients treated with wrist splints or other palliative measures such as cortisone injections will require followup in the ensuing 4 to 12 weeks to assess the success of treatment modalities β’ Patients treated surgically rarely experience recurrence of the disorder. Routine followup once healing of the incision has occurred is not necessary. PREVENTION/AVOIDANCE : Take a break once an hour when doing repetitive work involving hands POSSIBLE COMPLICATIONS : β’ Post-op infection (rare) β’ Injury to recurrent branch of the nerve EXPECTED COURSE/PROGNOSIS : Untreated the condition can be expected to lead to numbness and weakness in the hand with atrophy of hand muscles and permanent loss of function of the extremity
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
BLOOD SUGAR ( FASTING ), X-RAY WRIST JOINT A.P. & LAT. VIEW, BLOOD SUGAR ( AFTER MEALS ), COMPLETE BLOOD COUNT, NERVE CONDUCTION TEST, MRI, THYROID PROFILE
[CARPAL TUNNEL SYNDROME]