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    Carpal Tunnel Syndrome

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    Pathmanesan Pirakash
    The carpal tunnel is a fibro-osseous tunnel in the wrist bounded by carpal bones and the flexor retinaculum through which the median nerve and tendons pass. Carpal tunnel syndrome occurs when anything limits the space in the tunnel, compressing the median nerve and causing numbness, tingling and weakness. Diagnosis involves sensory and motor nerve tests and imaging. Treatment involves addressing underlying causes, splinting, steroid injections, and carpal tunnel release surgery if conservative measures fail.

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    Carpal Tunnel Syndrome

    Uploaded by

    Pathmanesan Pirakash
    102 views5 pages
    The carpal tunnel is a fibro-osseous tunnel in the wrist bounded by carpal bones and the flexor retinaculum through which the median nerve and tendons pass. Carpal tunnel syndrome occurs when anything limits the space in the tunnel, compressing the median nerve and causing numbness, tingling and weakness. Diagnosis involves sensory and motor nerve tests and imaging. Treatment involves addressing underlying causes, splinting, steroid injections, and carpal tunnel release surgery if conservative measures fail.

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    The carpal tunnel is a fibro-osseous tunnel in the wrist bounded by carpal bones and the flexor retinaculum through which the median nerve and tendons pass. Carpal tunnel syndrome occurs when anything limits the space in the tunnel, compressing the median nerve and causing numbness, tingling and weakness. Diagnosis involves sensory and motor nerve tests and imaging. Treatment involves addressing underlying causes, splinting, steroid injections, and carpal tunnel release surgery if conservative measures fail.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    102 views5 pages

    Carpal Tunnel Syndrome

    Uploaded by

    Pathmanesan Pirakash
    The carpal tunnel is a fibro-osseous tunnel in the wrist bounded by carpal bones and the flexor retinaculum through which the median nerve and tendons pass. Carpal tunnel syndrome occurs when anything limits the space in the tunnel, compressing the median nerve and causing numbness, tingling and weakness. Diagnosis involves sensory and motor nerve tests and imaging. Treatment involves addressing underlying causes, splinting, steroid injections, and carpal tunnel release surgery if conservative measures fail.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 5

    CARPAL TUNNEL SYNDROME

    ANATOMY

    a fibro-osseous tunnel formed by # concavity of carpal bones - posteriorly # flexor retinaculum - anteriorly

    Attachments of the flexor retinaculum Laterally-tubercle of scaphoid & crest of trapezium Medially-hook of hamate & pisiform bone

    Structures passing through the carpal tunnel Median nerve Flexor pollicis longus Flexor digitorum profundus Flexor digitorum superficialis Flexor carpi radialis (within a separate tunnel) Radial bursa Ulnar bursa

    tendons

    Structures superficial to the flexor retinaculum Palmaris longus tendon Ulnar artery & nerve Palmar cutaneous branch of median nerve

    PATHOPHYSIOLOGY As previously said, carpal tunnel is a fibro osseous tunnel. So, anything that limits the space in the tunnel cause compression of the median nerve. Continued compression leads to neuropraxia and, if not relieved, atrophy of the nerve.

    Aeiologies - ideopathic - dislocation of the lunate - arthritis - odematous synovial sheaths

    Clinical presentation in the early stages


    Numbness and tingling in the sensory distribution of the nerve, it worse at night. Patients are woken and have to dangle the wrist and shake it to relieve the discomfort

    In the late stages


    Weakness of grip, clumsiness and a tendency to drop objects

    Differential diagnosis of carpal tunnel syndrome

    Cervical spondylosis Cervical rib Syringomyelia Referred pain due to myocardial infarction Pancoasts syndrome Ulnar tunnel syndrome

    Examination

    Ask the patient what the dominant hand is. Compare with the opposite hand. See whether there is a scar suggestive of carpal tunnel decompression. Check for wasting of the thenar eminence Check sensory and motor functions of the median nerve in the hand. Pen touch test Keep the hand on a flat surface , instruct the patient to abduct the thumb against resistance of a pen. This test is done to assess Abductor pollicis brevis which is constantly supplied only by Median nerve. Pin prick test sensation over the thenar eminence is preserved because it is supplied by the palmar cutaneous branch of the median nerve. Tinels test tap on the flexor aspect of the wrist over the flexor retinaculum. Patient experiences a tingling sensation in the hand. Phalens test the patient is asked to flex both wrist to 900 and hold opposite to each other for 2-3 minutes. If the patient experiences pain test will be positive.

    Investigations nerve conduction velocity test- slowing of conduction over the wrist.

    Management

    Identify the risk factors Pregnancy Obesity Acromegaly Hypothyroidism Diabetes mellitus Amyloidosis Rheumatoid arthritis Old colles fracture Treat the cause weight loss, diuretics Definitive treatment is carpal tunnel decompression done in a bloodless field under local anaesthesia. Flexor retinaculum is divided to release pressure on median nerve.

    Complications of carpal tunnel decompression

    Recurrence due to incomplete division Painful neuroma Damage to the recurrent branch of the median nerve Damage to the main trunk of the median nerve Implantation dermoid Contractures Bleeding ( damage to the superficial and deep palmar arches)

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