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carpal tunnel syndrome re

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Reza Fahlevi

Carpal tunnel syndrome is a compressive neuropathy of the median nerve as it passes through the carpal tunnel in the wrist. It commonly affects the general population, with risk factors including female sex, obesity, pregnancy, rheumatoid arthritis, and repetitive motions. Symptoms include numbness and tingling in the thumb, index, middle and half of ring fingers, especially awakening the patient at night. Diagnosis involves physical exam findings like thenar atrophy and positive Tinel's and Phalen's tests. Conservative treatment includes splinting, activity modification, and steroid injections, while surgery involves carpal tunnel release if conservative measures fail.

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RE BAGIAN ORTOPEDI &TRAUMATOLOGI FAKULTAS KEDOKTERAN UNHAS MAKASSAR
Most common compressive neuropathy pathologic (inflamed) synovium most common cause of idiopathic CTS
affects 0.1-10% of general population risk factors female sex obesity pregnancy hypothyroidism rheumatoid arthritis advanced age chronic renal failure smoking alcoholism repetitive motion activities mucopolysaccharidosis mucolipidosis
precipitated by exposure to repetitive motions and vibrations certain athletic activities cycling tennis throwing pathoantomy compression may be due to repetitive motions in a patient with normal anatomy space occupying lesions (e.g., gout)
good prognostic indicators include night symptoms short incisions relief of symptoms with steroid injections not improved when incomplete release of transverse carpal ligament is discovered
carpal tunnel syndrome re
Carpal tunnel defined by scaphoid tubercle and trapezium radially hook of hamate and pisiform ulnarly transverse carpal ligament palmarly (roof) proximal carpal row dorsally (floor)
Carpal tunnel consists of nine flexor tendons one nerve (median nerve) FPL is the most radial structure
Symptoms numbness and tingling in radial 3- 1/2 digits clumsiness pain and paresthesias that awaken patient at night self administered hand diagram the most specific test (76%) for carpal tunnel syndrome
thenar atrophy Durkan's test Phalen test Tinel's test Semmes-Weinstein testing innervation density test
numbness and tingling in the median nerve distribution nocturnal numbness weakness and/or atrophy of the thenar musculature positiveTinel sign positive Phalen test loss of two point discrimination
NSAIDS, night splints, activity modifications steroid injections indications adjunctive conservative treatment diagnostic utility in clinically and electromyographically equivocal cases outcomes 80% have transient improvement of symptoms (of these 22% remain symptoms free at one year) failure to improve after injection is poor prognostic factor surgery is less effective in these patients 25% will have no relief
carpal tunnel release indications failure of nonoperative treatment (including steroid injections) acute CTS followingORIF of a distal radius fx outcomes pinch strength return in 6 week grip strength is expected to return to 100% preoperative levels by 12 weeks postop rate of continued symptoms at 1+ year is 2% in moderate and 20% in severe CTS

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carpal tunnel syndrome re

  • 1. RE BAGIAN ORTOPEDI &TRAUMATOLOGI FAKULTAS KEDOKTERAN UNHAS MAKASSAR
  • 2. Most common compressive neuropathy pathologic (inflamed) synovium most common cause of idiopathic CTS
  • 3. affects 0.1-10% of general population risk factors female sex obesity pregnancy hypothyroidism rheumatoid arthritis advanced age chronic renal failure smoking alcoholism repetitive motion activities mucopolysaccharidosis mucolipidosis
  • 4. precipitated by exposure to repetitive motions and vibrations certain athletic activities cycling tennis throwing pathoantomy compression may be due to repetitive motions in a patient with normal anatomy space occupying lesions (e.g., gout)
  • 5. good prognostic indicators include night symptoms short incisions relief of symptoms with steroid injections not improved when incomplete release of transverse carpal ligament is discovered
  • 7. Carpal tunnel defined by scaphoid tubercle and trapezium radially hook of hamate and pisiform ulnarly transverse carpal ligament palmarly (roof) proximal carpal row dorsally (floor)
  • 8. Carpal tunnel consists of nine flexor tendons one nerve (median nerve) FPL is the most radial structure
  • 9. Symptoms numbness and tingling in radial 3- 1/2 digits clumsiness pain and paresthesias that awaken patient at night self administered hand diagram the most specific test (76%) for carpal tunnel syndrome
  • 10. thenar atrophy Durkan's test Phalen test Tinel's test Semmes-Weinstein testing innervation density test
  • 11. numbness and tingling in the median nerve distribution nocturnal numbness weakness and/or atrophy of the thenar musculature positiveTinel sign positive Phalen test loss of two point discrimination
  • 12. NSAIDS, night splints, activity modifications steroid injections indications adjunctive conservative treatment diagnostic utility in clinically and electromyographically equivocal cases outcomes 80% have transient improvement of symptoms (of these 22% remain symptoms free at one year) failure to improve after injection is poor prognostic factor surgery is less effective in these patients 25% will have no relief
  • 13. carpal tunnel release indications failure of nonoperative treatment (including steroid injections) acute CTS followingORIF of a distal radius fx outcomes pinch strength return in 6 week grip strength is expected to return to 100% preoperative levels by 12 weeks postop rate of continued symptoms at 1+ year is 2% in moderate and 20% in severe CTS