Carpal tunnel syndrome: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
===History=== | ===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 with burning pain and tingling in hand | *Awakening at night with burning pain and tingling in hand | ||
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====Proximal Lesion==== | ====Proximal Lesion==== | ||
*[[Spinal cord compression (non-traumatic)|Spinal cord lesion]] | *[[Spinal cord compression (non-traumatic)|Spinal cord lesion]] | ||
*[[Neck pain|Cervical | *[[Neck pain|Cervical radicular pain]] | ||
*Thoracic outlet syndrome | *[[Thoracic outlet syndrome]] | ||
*[[Multiple Sclerosis (MS)]] | *[[Multiple Sclerosis (MS)]] | ||
====Distal Lesion==== | ====Distal Lesion==== | ||
*Ulna neuropathy | *Ulna neuropathy | ||
====Systemic condition==== | ====Systemic condition==== | ||
*Raynaud syndrome | *[[raynaud's disease|Raynaud syndrome]] | ||
*[[Pregnancy (Main)]] | *[[Pregnancy (Main)]] | ||
*[[Anemia|B12 deficiency]] | *[[Anemia|B12 deficiency]] | ||
Revision as of 00:07, 3 October 2019
Background
- Also known as "Median Mononeuropathy"
- 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
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
- Sensation testing
- Most specific - splitting of 4th digit in which medial aspect of 4th digit normal and lateral aspect abnormal
- Most sensitive - abnormal sensation of distal palmar tip of 2nd digit
- LOAF muscle weakness as compared to other hand - Lumbricals, with thumb Opposition, Abduction, Flexion
- Tinel sign - poorly sensitive and specific
- 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
By Type of Lestion
Proximal Lesion
Distal Lesion
- Ulna neuropathy
Systemic condition
Upper extremity peripheral nerve syndromes
Median Nerve Syndromes
Ulnar Nerve Syndromes
Radial Nerve Syndromes
- Radial neuropathy at the spiral groove (ie. "Saturday night palsy")
- Posterior interosseous neuropathy
Proximal Neuropathies
- Suprascapular neuropathy
- Long thoracic neuropathy
- Axillary neuropathy
- Spinal accessory neuropathy
- Musculocutaneous neuropathy
Other
Management
- See this American Academy of Orthopedic Surgeons clinical decision tool for treatment options and disposition - CTS guidelines
- 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
- Discharge
See Also
References
- ↑ 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.