Carpal tunnel syndrome: Difference between revisions
Neil.m.young (talk | contribs) No edit summary |
Neil.m.young (talk | contribs) No edit summary |
||
| Line 39: | Line 39: | ||
*[[Hypocalcemia]] | *[[Hypocalcemia]] | ||
== | ==Management== | ||
*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== | ==See Also== | ||
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
- Spinal cord lesion
- Cervical redicular pain
- Thoracic outlet syndrome
- Multiple Sclerosis (MS)
Distal Lesion
- Ulna neuropathy
Systemic condition
- Raynaud syndrome
- Pregnancy (Main)
- B12 deficiency
- Diabetic neuropathy
- Hypothyroidism
- Hypocalcemia
Management
- 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
- Marx, John A. et al. "Wrist and Forearm." Rosen's Emergency Medicine: Concepts and Clinical Practice. Eighth ed. Vol. 1. Elsevier, 2014. 588-589.
- ↑ 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.