Carpal Tunnel Syndrome: Difference between revisions
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== Clinical Presentation == | == Clinical Presentation == | ||
The clinical features of this syndrome include intermittent pain and paresthesias in median nerve distribution of the hand, muscle weakness, and night pain | The clinical features of this syndrome include intermittent pain and paresthesias in median nerve distribution of the hand, muscle weakness, and night pain Usually, people with carpal tunnel syndrome first notice a numbness or "fallng asleep" sensation in their thumb, index and middle finger at night. As the symptoms progress, people with carpal tunnel may complain of burning pain and numbness along the median nerve distribution (thumb, index finger and lateral half of d digit on palmar side) up into the center of their forearm. | ||
== Diagnostic Procedures == | == Diagnostic Procedures == | ||
Revision as of 22:35, 2 July 2009
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Clinically Relevant Anatomy
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add text here relating to clinically relevant anatomy of the condition
Mechanism of Injury / Pathological Process
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Carpal Tunnel Syndrome (CTS) is a cause of functional impairment and chronic wrist pain of the hand. It results from compression of the median nerve as it passes through the carpal tunnel. An increase in synovial fluid pressure and tendon tension/inflmmation can cause compression of the median nerve in the carpal tunnel. Excessive repetitive movements of the arms, wrists or hands from activities such as painting or typing can aggravate the carpal tunnel bringing out the symptoms of carpal tunnel syndrome.
The compression of the median nerve may results from numerous factors, several of which can easily be remembered by using the mnemonic PRAGMATIC: Pregnancy secondary to fluid retension, Renal dysfunction, Acromegaly, Gout and pseudogout, Myxedema or mass, Amyotrophy, Trauma, Infection, and Collagen disorders.[1]
Clinical Presentation[edit | edit source]
The clinical features of this syndrome include intermittent pain and paresthesias in median nerve distribution of the hand, muscle weakness, and night pain Usually, people with carpal tunnel syndrome first notice a numbness or "fallng asleep" sensation in their thumb, index and middle finger at night. As the symptoms progress, people with carpal tunnel may complain of burning pain and numbness along the median nerve distribution (thumb, index finger and lateral half of d digit on palmar side) up into the center of their forearm.
Diagnostic Procedures[edit | edit source]
Median nerve conduction study and EMG study are two diagnostic test that can be performed to diagnosis CTS.
Tinel’s sign and Phalen’s test are two special test that can be performed in the clinic to help diagnose. Wainner et al developed a clinical perdiction rule to help test for the presence of CTS. The rule consist of 5 predictor variables: Age greater than 45, patient reports shaking hands relieves symptoms, wrist ratio index >.67, reduced median sensory field of the first digit, and Symptom Severity Scale score >1.9.[2]
Outcome Measures
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Outcome Measures Symptom Severity Scale
DASH - Disability of arm, shoulder and hand
Management / InterventionsConservative[edit | edit source]
Managment includes use of splints, activity modification, pt education, diuretics, and NSAIDs
Differential Diagnosis
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Differential diagnosis for CTS includes cervical radiculopathy, thoracic outlet syndrome, pronator syndrome, wrist joint arthritis, tendonitis, and fibrositis.[1]
Key Evidence[edit | edit source]
add text here relating to key evidence with regards to any of the above headings
Resources [edit | edit source]
Dutton, M. Orthopaedic examination, evaluation, and intervention. New York: McGraw Hill; 2004.
Flynn TW, Cleland JA, Whitman JM. Users' guide to the musculoskeletal examination. Fundamentals for the evidence-based clinician. United States:Evidence in Motion; 2008.
Case Studies[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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