Carpal tunnel syndrome: Difference between revisions
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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 | |||
**Raynaud syndrome | |||
**[[Pregnancy (Main)]] | |||
**[[Anemia|B12 deficiency]] | |||
**[[Diabetes Mellitus (Main)|Diabetic neuropathy]] | |||
**[[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
- Proximal Lesion
- Spinal cord lesion
- Cervical redicular pain
- Thoracic outlet syndrome
- Multiple Sclerosis (MS)
- Systemic condition
- Raynaud syndrome
- Pregnancy (Main)
- B12 deficiency
- Diabetic neuropathy
- Hypothyroidism
- Hypocalcemia
- Ulna neuropathy
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
- ↑ 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.