Carpal Tunnel Syndrome. Anatomy Distribution Signs & Symptoms Pain – Worse at night Paraesthesia – Sparing the Thenar Eminence Weakness and Atrophy.

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Carpal Tunnel Syndrome

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Presentation transcript:

Carpal Tunnel Syndrome

Anatomy

Distribution

Signs & Symptoms Pain – Worse at night Paraesthesia – Sparing the Thenar Eminence Weakness and Atrophy of Thenar Muscles

Aetiology Intermittent or sustained high tissue pressure in the Carpal tunnel impairs microvascular circulation in the median nerve and leads to spurious generation of action potential, local demyelination, and ultimately axonal loss. Various underlying causes

Risk Factors and Associated Features Genetic predisposition Caucasian Age >30 Female High BMI Tunnel Structure Arthritis Pregnancy Trauma/ Fractures Overuse injuries Diabetes Dialysis Use of Mobility Aids Hypothyroidism Amyloidosis Acromegaly

Diagnosis Clinical Tinel’s Phalen’s Nerve Conduction Studies Additional Investigations

Management Conservative Medication Surgical

Conservative ‘Lifestyle’ Rest Hand-splints TENS Physiotherapy

Medication Corticosteroid/ Local Anaesthetic Injection Non-Steroidal Anti-Inflammatory Drugs Underlying causes/ issues Eg. Hydrochlorothiazide mg/day orally for 2/52 course

Surgical Carpal Tunnel Release For failure of medical therapy For severe ENG findings

Brachial Plexus Crush Syndrome Damage in one area increases the likelihood of damage elsewhere along the nerve Carpal Tunnel + Bellies of Pronator Terries Carpal Tunnel + Cervical Radiculopathy

Bland JDP. Carpal Tunnel Syndrome. British Medical Journal. 335 (7615): De Rijk MC, et al. Does Carpal tunnel syndrome predict an underlying cause? Journal of Neurology, Neurosurgery & Psychiatry. 78 (6): Van Dijk MA, et al. Indications for requesting laboratory tests for concurrent diseases in patients with carpal tunnel syndrome: a systematic review. Clin Chem BMJ Best Practice. Last updated 2014 Aug 11. Viewed 2014 September Kumar P, Clark M (Ed.). Kumar & Clark’s Clinical Medicine. 7 th Edn. Saunders Elsevier East Kent Hospital Foundation. NHS Trust. Double Crush Syndrome. Carpal-Tunnel.net. Revised 2012 Feb 24. Viewed 2014 September Osterman AL. The double crush syndrome. Orthop Clin North Am. 19 (1): Flak M, et al. Double Crush Syndrome Evaluation in the Median Nerve in Clinical, Radiological and Electrophysiological Examination. Studies Health Technology Information. 123 (5):

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