Carpal tunnel syndrome: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
===History=== | |||
*Pain, paresthesia, and numbness in distribution of median nerve | *Pain, paresthesia, and numbness in distribution of median nerve | ||
**Palmar aspect of thumb, index, middle, and radial aspect of ring finger | **Palmar aspect of thumb, index, middle, and radial aspect of ring finger | ||
*Awakening at night w/ burning pain and tingling in hand | *Awakening at night w/ burning pain and tingling in hand | ||
===Physical=== | |||
*Tinel sign | *Tinel sign | ||
**Tapping on palmar aspect of wrist reuslts in electric shock sensation shooting into hand | **Tapping on palmar aspect of wrist reuslts in electric shock sensation shooting into hand | ||
**SN 0.50 and SP 0.77<ref>MacDermid JC and Wessel J. Clinical diagnosis of carpal tunnel syndrome: a systematic review. J Hand Ther. 2004; 17(2):309.</ref> | |||
*Phalen maneuver | *Phalen maneuver | ||
**Holding wrists in flexion for 60 seconds evokes or worsens symptoms | **Holding wrists in flexion for 60 seconds evokes or worsens symptoms | ||
*Durkan sign | **SN 0.68 and SP 0.73<ref>MacDermid JC and Wessel J. Clinical diagnosis of carpal tunnel syndrome: a systematic review. J Hand Ther. 2004; 17(2):309.</ref> | ||
**Manual compression of carpal tunnel reproduces symptoms | *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<ref>Durkan, JA. A new diagnostic test for carpal tunnel syndrome, The Journal of Bone and Joint Surgery. 1991; 73(4):535–538.</ref> | |||
==Differential Diagnosis== | ==Differential Diagnosis== |
Revision as of 13:02, 12 February 2015
Background
- Most common focal mononeuropathy
- Results from compression of median nerve at wrist where it traverses the carpal tunnel
- Etiology:
- Repetitive wrist flexion/extension, DM, amyloidosis, trauma, edema
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 w/ 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
Treatment
- Behavioral modification
- Wrist splint w/ wrist in neutral position
- NSAIDs (although not clearly effective)
- Diuretics (if edema is significant contributor to pt's symptoms)
See Also
Source
Tintinalli
- ↑ 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.