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Carpal Tunnel Syndrome Hand/Finger/Wrist Issues. 2 Presentation: A 64-year-old, right-handed, retired woman presents with: intermittent numbness, tingling,

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Presentation on theme: "Carpal Tunnel Syndrome Hand/Finger/Wrist Issues. 2 Presentation: A 64-year-old, right-handed, retired woman presents with: intermittent numbness, tingling,"— Presentation transcript:

1 Carpal Tunnel Syndrome Hand/Finger/Wrist Issues

2 2 Presentation: A 64-year-old, right-handed, retired woman presents with: intermittent numbness, tingling, and burning pain Location: The three radial digits of both hands Duration: Had these symptoms for three months History: These symptoms awaken her several times each night. On examination: She has no atrophy of the thenar muscles. Sensation to light touch is intact. How should she be evaluated and treated?

3 3 Scope of the problem 2.7 million office visits Differential diagnosis: Entrapments of the nerves- Carpal tunnel syndrome, Entrapment of the ulnar nerve Cervical radiculopathy Tendon disorders, Overuse of muscles, Nonspecific pain syndromes

4 4 CT Anatomy

5 5 CTS Data F: 3%, M:2%, Average age: 55 yrs F: 3%, M:2%, Average age: 55 yrs Elevated pressure in the carpal tunnel Results in ischemia of the median nerve Causes impaired nerve conduction and attendant paresthesia and pain Related Conditions: Pregnancy Inflammatory arthritis- RA Colles fracture Amyloidosis Hypothyroidism Diabetes mellitus 6% Acromegaly Use of corticosteroids and estrogens

6 6 CTS: Occupational Repetitive activities of the hand and wrist particularly with a combination of forceful and repetitive activities: Food processing Manufacturing Logging Construction work Data entry

7 7 History Pain, tingling, burning, numbness, or some combination of these symptoms on the palmar aspect of the thumb, index finger, middle finger, and radial half of the ring finger No such symptoms affect the fifth finger Nocturnal symptoms reported (51-77%) Flick Sign: Shake the symptomatic hand or hands when symptoms are at their worst gives relief

8 8 Assessment Late signs: Loss of two-point discrimination in the median nerve distribution Thenar atrophy Phalens maneuver: Flexion of the wrist for 60 seconds elicits pain or paresthesia in the median-nerve distribution (40-80%) Tinels sign: Present if tapping lightly over the volar surface of the wrist causes radiating paresthesia in the digits innervated by the median nerve (67-87%)

9 9 Therapies Treat associated conditions Treat associated conditions Wrist splint alleviates symptoms (80%); maintain the wrist in neutral posture rather than in extension Medications- ?NSAIDs, B6 Prednisone helps (10mg/day) Local Corticosteroid Injection (75% relief) symptoms recur within 1 yr (Poor prognosis: constant numbness, impaired sensibility, and weakness or thenar muscular atrophy) Limit injections to 3/yr

10 10 ?Surgery Carpal-tunnel–release surgery (on demand) Indications: constant numbness, symptoms for more than one year, loss of sensibility, and thenar muscular atrophy or weakness Direct or endoscopic carpal ligament release Endoscopic – increased risk of median nerve injury/ benefit earlier return to work mini-open release 70-90% success in pain relief Electro-diagnostic studies help to choose patients

11 11 Surgical Scars

12 12 ?Alternative Therapies not been evaluated yoga-based stretching, strengthening, and relaxation chiropractic therapy minimize forceful hand and wrist activities acupuncture, dietary supplements

13 13

14 14 U/S imaging


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