Daily Bolus of LR: Carpal Tunnel

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September 2, 2011 by dailybolusoflr

Carpal Tunnel


·         Carpal tunnel is a median mononeuropathy with impingement at the level of the carpal tunnel.

·         Certain conditions such as diabetes, hypothyroidism and pregnancy are associated with carpal tunnel syndrome.


·         Symptoms:

o   Most common are sensory symptoms such pain, burning, paresthesias, and numbness.

o   Motor symptoms are less common, and affect the median intrinsics, weakening thumb opposition and abduction.

o   Both types of symptoms are present in a median nerve distribution (palmer aspect of thumb, pointer finger, middle finger and radial half of ring finger). http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/1081.jpg


o   Sometimes patients may have poorly localized symptoms extending to the forearm or arm.

o   Exacerbation of symptoms often occurs at night, with hand-shaking, with driving and with repetitive activities such as typing or knitting.

·         Tests: The symptoms are often reproducible in a median nerve distribution with the following maneuvers

o   Phalen’s sign

§  by flexion of wrist for 1 minute

o   Tinel’s sign

§   tapping of the volar aspect at the wrist crease over the median nerve

·         ED treatment

o   Conservative management of carpal tunnel syndrome is appropriate for patients with only sensory complaints

o   Volar splints (especially used at nighttime) and regularly scheduled NSAIDs are often attempted first for a period of 4-6 weeks in patients.

o   If symptoms fail to improve then consulting a hand surgeon for corticosteroid injections, nerve conduction studies and operative carpal tunnel release is recommended.

o   IF patients present already with motor findings, a referral to a hand surgeon as an outpatient (expeditiously) is recommended


Ref: Rosen’s EM

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