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)]] | |
| − | + | ===Distal Lesion=== | |
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
| − | |||
*Ulna neuropathy | *Ulna neuropathy | ||
| + | ===Systemic condition=== | ||
| + | *Raynaud syndrome | ||
| + | *[[Pregnancy (Main)]] | ||
| + | *[[Anemia|B12 deficiency]] | ||
| + | *[[Diabetes Mellitus (Main)|Diabetic neuropathy]] | ||
| + | *[[Hypothyroidism]] | ||
| + | *[[Hypocalcemia]] | ||
==Treatment== | ==Treatment== | ||
Revision as of 23:24, 11 January 2016
Contents
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 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
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
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
- Marx, John A. et al. "Wrist and Forearm." Rosen's Emergency Medicine: Concepts and Clinical Practice. Eighth ed. Vol. 1. Elsevier, 2014. 588-589.
- ↑ 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.