CARPAL TUNNEL SYNDROME Magdy Dahab November 6 th
CARPAL TUNNEL SYNDROME Magdy Dahab November 6 th, 2018
epidemiology Affects an estimated 3 percent of adults Three times more common in women than in men High prevalence rates have been reported in persons who perform certain repetitive wrist motions (frequent computer users) • 30% hand paresthesias • 10% clinical criteria for carpal tunnel syndrome • 3. 5% abnormal nerve conduction studies Magdy Dahab Carpal Tunnel Syndrome 2
Nerve Compression Magdy Dahab Carpal Tunnel Syndrome 3
Magdy Dahab Carpal Tunnel Syndrome 4
Risk factors Obesity Hypothyroidism Diabetes (prevalence 14%-30% with neuropathy) Pregnancy (~50% prevalence) Renal disease Inflammatory arthritis Acromegaly Genetics (twin study) Age (>50) Smoking Magdy Dahab Carpal Tunnel Syndrome 5
Clinical Features Pain Numbness Tingling Symptoms are usually worse at night and can awaken patients from sleep. To relieve the symptoms, patients often “flick” their wrist as if shaking down a thermometer (flick sign). Magdy Dahab Carpal Tunnel Syndrome 6
CTS Symptoms Usually worsen at night and can awaken patients from sleep + flick sign Exacerbated when driving or talking on the phone Frequently dropping objects, weak grip Fatigues with repetitive activity Magdy Dahab Carpal Tunnel Syndrome 7
Atrophy Magdy Dahab Carpal Tunnel Syndrome 8
Physical Examination Visual Inspection Asymmetry Skin Changes Strength Sensation Light touch/Pinprick Vibration 2 point discrimination Provocative Maneuvers Magdy Dahab Carpal Tunnel Syndrome 9
Physical Examination Tinel’s sign Phalen Maneuver Reverse Phalen Carpal Compression Durkan’s Magdy Dahab Carpal Tunnel Syndrome 10
Tinel’s sign Magdy Dahab Carpal Tunnel Syndrome 11
Phalen’s maneuver Magdy Dahab Carpal Tunnel Syndrome 12
Electrodiagnosis Nerve Conduction Studies Electromyography Magdy Dahab Carpal Tunnel Syndrome 13
Conditions associated with CTS Multiple Myeloma Rheumatoid Arthritis Pregnancy Amyloidosis A/V dialysis shunts Endocrine/Pituitary abnormalities Hypothyroidism acromegaly Magdy Dahab Carpal Tunnel Syndrome 14
Differential Diagnostics Tendonitis Tenosynovitis Diabetic neuropathy Kienbock's disease Compression of the Median nerve at the elbow Magdy Dahab Carpal Tunnel Syndrome 15
Treatment Conservative Activity modification Wrist splints Corticosteroid injection US therapy Nerve gliding Medications �Vitamin B 6 �NSAIDs v oral steroids Surgical Open v Endoscopic carpal tunnel release {CTR} Magdy Dahab Carpal Tunnel Syndrome 16
Magdy Dahab Carpal Tunnel Syndrome 17
LOCAL INJECTION Magdy Dahab Carpal Tunnel Syndrome 18
SURGERY Should be considered in patients with symptoms that do not respond to conservative measures and in patients with severe nerve entrapment as evidenced by nerve conduction studies, thenar atrophy, or motor weakness. It is important to note that surgery may be effective even if a patient has normal nerve conduction studies Magdy Dahab Carpal Tunnel Syndrome 19
PREGNANCY Alterations in fluid balance may predispose some pregnant women to develop carpal tunnel syndrome. Symptoms are typically bilateral and first noted during the third trimester. Conservative measures are appropriate, because symptoms resolve after delivery in most women with pregnancy-related carpal tunnel syndrome. Magdy Dahab Carpal Tunnel Syndrome 20
Conclusion Most common focal peripheral neuropathy Pain and paresthesias in the distribution of the median nerve are the classic symptoms. While Tinel’s sign and a positive Phalen’s maneuver are classic clinical signs of the syndrome, hypalgesia and weak thumb abduction are more predictive of abnormal nerve conduction studies. Magdy Dahab Carpal Tunnel Syndrome 21
Thank You! Magdy Dahab Carpal Tunnel Syndrome 22
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