carpal tunnel syndrome

Question 1

carpal tunnel syndrome

Answer 1

entrapment of the median nerve at the wrist. Most common compression neuropathy in the upper extremity. It most commonly affects middle aged or pregnant women

Question 2

SX

Answer 2

paresthesias, pain, and sometimes paralysis.

Vague aching that radiates into the thenar area. Aching also may be preceived in the proximal forearm, and occasionally the pain can extend to the shoulder.

Worse at night.

frequently drop objects or open jars.

Question 3

precipitating conditions

Answer 3

tenosynovitis of the adjacent flexor tendons (reptitive overuse trauma or rheumatoid arthritis), tumors, and medical conditions such as pregnany, diabetes mellitus, and thyroid dysfunction

Question 4

physical examination

Answer 4

insepct hand for the thenar atrophy.\

thumb opposition against resistance may reveal weakness of the thenar muscles.

evaluate sensation.

may not be able to discriminate two point of 5 mm.

Question 5

phalen maneuver

Answer 5

placing the wrists in flexion. Avoid excessive elbow flesion when performing this test. Aching and numbness in teh distribution of the median nerve within 60 secs. is a positive test for carpal tunnel syndrome.

Question 6

diagnostic test

Answer 6

radiographs

electrophysiologic testing: some patients have no clinical signs or symptoms yet have abnormal nerve conduction velocity stuides. People with carpal tunnel may show normal conduction.

Question 7

Differential diagnosis

Answer 7

arthritis of carpometacarpal joint of the thumb

cervical radiculopathy affecting C6 nerve (neck pain, numbness in the thumb and index fingers only)

diabetes mellitus with neuropathy (history0

flexor carpi radialis tenosynovitis (tenderness near the base of the thumb)

hypothyrodism (abnormal results of thyroid function test)

median nerve compression at the elbow (tenderss at the proximal forearm)

ulnar neuropathy (first dorsal interosseous weakness, numbness of the ring and little finger.)

volar radial ganglion (mass near the base of the thumb above the wrist flexion crease

wrist arthritis (limited motion, evident on radiographs)

Question 8

Adverse outcomes of the disease

Answer 8

permanent loss of sensation, hand strenght, and fine motor skills are possible

Question 9

TX

Answer 9

fo