Difference between revisions of "Carpal tunnel syndrome"

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==Differential Diagnosis==
 
==Differential Diagnosis==
 +
*Proximal Lesion
 +
**[[Spinal cord compression (non-traumatic)|Spinal cord lesion]]
 +
**[[Neck pain|Cervical redicular pain]]
 +
**Thoracic outlet syndrome
 +
**[[Multiple Sclerosis (MS)]]
 +
*Systemic condition
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**Raynaud syndrome
 +
**[[Pregnancy (Main)]]
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**[[Anemia|B12 deficiency]]
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**[[Diabetes Mellitus (Main)|Diabetic neuropathy]]
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**[[Hypothyroidism]]
 +
**[[Hypocalcemia]]
 +
*Ulna neuropathy
  
 
==Treatment==
 
==Treatment==

Revision as of 13:13, 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

  1. Behavioral modification
  2. Wrist splint w/ wrist in neutral position
  3. NSAIDs (although not clearly effective)
  4. Diuretics (if edema is significant contributor to pt's symptoms)

See Also

Source

Tintinalli

  1. MacDermid JC and Wessel J. Clinical diagnosis of carpal tunnel syndrome: a systematic review. J Hand Ther. 2004; 17(2):309.
  2. MacDermid JC and Wessel J. Clinical diagnosis of carpal tunnel syndrome: a systematic review. J Hand Ther. 2004; 17(2):309.
  3. Durkan, JA. A new diagnostic test for carpal tunnel syndrome, The Journal of Bone and Joint Surgery. 1991; 73(4):535–538.