September 2, 2011 by dailybolusoflr
· 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.
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