Carpal tunnel syndrome: Difference between revisions
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*Etiology: repetitive wrist flexion/extension, trauma, edema | *Etiology: repetitive wrist flexion/extension, trauma, edema | ||
===Risk factors=== <ref>Kothari MJ. Carpal tunnel syndrome: Etiology and epidemiology. Post TW, ed. UpToDate. UpToDate Inc. Accessed May 21, 2020.</ref> | ===Risk factors=== | ||
<ref>Kothari MJ. Carpal tunnel syndrome: Etiology and epidemiology. Post TW, ed. UpToDate. UpToDate Inc. Accessed May 21, 2020.</ref> | |||
*Female sex | *Female sex | ||
*[[Rheumatoid arthritis]] and other connective tissue diseases | *[[Rheumatoid arthritis]] and other connective tissue diseases | ||
Revision as of 05:34, 15 January 2021
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
- Female sex
- Rheumatoid arthritis and other connective tissue diseases
- Diabetes mellitus
- 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
- 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[2]
- Phalen maneuver
- Holding wrists in flexion for 60 seconds evokes or worsens symptoms
- SN 0.68 and SP 0.73[3]
- 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[4]
- Hand Elevation Test
- Performed by having patient elevated both hands above the head
- Positive if paresthesia, numbness, or dull pain felt within two minutes
- SN 0.87 and SP 0.89[5]
- May see atrophy of thenar eminence in advanced cases
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
- ↑ Kothari MJ. Carpal tunnel syndrome: Etiology and epidemiology. Post TW, ed. UpToDate. UpToDate Inc. Accessed May 21, 2020.
- ↑ 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.
- ↑ Ma H, Kim I. The diagnostic assessment of hand elevation test in carpal tunnel syndrome. J Korean Neurosurg Soc. 2012;52(5):472-475. doi:10.3340/jkns.2012.52.5.472