Carpal tunnel syndrome: Difference between revisions
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==Management== | ==Management== | ||
*See this American Academy of Orthopedic Surgeons clinical decision tool for treatment options and disposition - [http://www.orthoguidelines.org/go/auc/auc.cfm?auc_id=224989 CTS guidelines] | |||
*Behavioral modification | *Behavioral modification | ||
*Wrist splint with wrist in neutral position | *Wrist splint with wrist in neutral position |
Revision as of 20:09, 13 December 2016
Background
- Most common focal mononeuropathy
- Results from compression of median nerve at wrist where it traverses the carpal tunnel
- Median nerve provides sensation to the palmar aspect digits 1-3 and radial side of 4th
- Etiology: repetitive wrist flexion/extension, trauma, edema
- Risk factors: DM, amyloidosis, obesity, pregnancy, hypothyroidism
Clinical Features
History
- Pain, paresthesia, and numbness in distribution of median nerve
- Palmar aspect of thumb, index, middle, and radial aspect of ring finger
- Awakening at night with burning pain and tingling in hand
Physical
- Tinel sign
- Tapping on palmar aspect of wrist reuslts in electric shock sensation shooting into hand
- SN 0.50 and SP 0.77[1]
- Phalen maneuver
- Holding wrists in flexion for 60 seconds evokes or worsens symptoms
- SN 0.68 and SP 0.73[2]
- Durkan sign
- Manual compression of carpal tunnel reproduces symptoms after 30 seconds
- SN 0.64 and SP 0.83
- More sensitive and specific than Tinel and Phalen in earlier studies[3]
Differential Diagnosis
Proximal Lesion
- Spinal cord lesion
- Cervical redicular pain
- Thoracic outlet syndrome
- Multiple Sclerosis (MS)
Distal Lesion
- Ulna neuropathy
Systemic condition
- Raynaud syndrome
- Pregnancy (Main)
- B12 deficiency
- Diabetic neuropathy
- Hypothyroidism
- Hypocalcemia
Management
- See this American Academy of Orthopedic Surgeons clinical decision tool for treatment options and disposition - CTS guidelines
- Behavioral modification
- Wrist splint with wrist in neutral position
- NSAIDs (although not clearly effective)
- Diuretics (if edema is significant contributor to patient's symptoms)
Disposition
Out-patient
See Also
References
- ↑ MacDermid JC and Wessel J. Clinical diagnosis of carpal tunnel syndrome: a systematic review. J Hand Ther. 2004; 17(2):309.
- ↑ MacDermid JC and Wessel J. Clinical diagnosis of carpal tunnel syndrome: a systematic review. J Hand Ther. 2004; 17(2):309.
- ↑ Durkan, JA. A new diagnostic test for carpal tunnel syndrome, The Journal of Bone and Joint Surgery. 1991; 73(4):535–538.