Difference between revisions of "Carpal tunnel syndrome"

(Text replacement - "pt's" to "patient's")
(Text replacement - " w/ " to " with ")
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*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 with burning pain and tingling in hand
 
===Physical===
 
===Physical===
 
*Tinel sign
 
*Tinel sign
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==Management==
 
==Management==
 
*Behavioral modification
 
*Behavioral modification
*Wrist splint w/ wrist in neutral position
+
*Wrist splint with wrist in neutral position
 
*NSAIDs (although not clearly effective)
 
*NSAIDs (although not clearly effective)
 
*Diuretics (if edema is significant contributor to patient's symptoms)
 
*Diuretics (if edema is significant contributor to patient's symptoms)

Revision as of 17:21, 11 July 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

Distal Lesion

  • Ulna neuropathy

Systemic condition

Management

  • 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

  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.