Difference between revisions of "Carpal tunnel syndrome"

(Background)
Line 24: Line 24:
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
*Proximal Lesion
+
===Proximal Lesion===
**[[Spinal cord compression (non-traumatic)|Spinal cord lesion]]
+
*[[Spinal cord compression (non-traumatic)|Spinal cord lesion]]
**[[Neck pain|Cervical redicular pain]]
+
*[[Neck pain|Cervical redicular pain]]
**Thoracic outlet syndrome
+
*Thoracic outlet syndrome
**[[Multiple Sclerosis (MS)]]
+
*[[Multiple Sclerosis (MS)]]
*Systemic condition
+
===Distal Lesion===
**Raynaud syndrome
 
**[[Pregnancy (Main)]]
 
**[[Anemia|B12 deficiency]]
 
**[[Diabetes Mellitus (Main)|Diabetic neuropathy]]
 
**[[Hypothyroidism]]
 
**[[Hypocalcemia]]
 
 
*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

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

Distal Lesion

  • Ulna neuropathy

Systemic condition

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
  • Marx, John A. et al. "Wrist and Forearm." Rosen's Emergency Medicine: Concepts and Clinical Practice. Eighth ed. Vol. 1. Elsevier, 2014. 588-589.
  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.