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Carpal tunnel syndrome
Carpal tunnel syndrome involves pressure on the median nerve as it passes through the carpal tunnel in the wrist. Common symptoms include numbness, tingling, and weakness in the hand and fingers. The cause is often unknown but may involve repetitive wrist motions, swelling from conditions like arthritis or pregnancy, or certain anatomical factors. Diagnosis involves physical exams like Tinel's sign and Phalen's maneuver as well as nerve conduction studies or EMG tests. Treatment ranges from splinting, anti-inflammatory drugs, corticosteroid injections, surgery to release pressure on the nerve. Rehabilitation after surgery focuses on scar tissue massage, modalities to reduce pain and swelling, and exercises to strengthen the hand muscles and improve function.
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Overview by Dr. Margarita Correa on Carpal Tunnel Syndrome, focusing on its medical aspects.
Discussion of wrist anatomy, including the carpal tunnel and median nerve, crucial for understanding CTS.
Symptoms include numbness, tingling, pain in the hands, and muscle weakness, affecting finger movement.
Various causes like unknown origins, swelling, injuries, and conditions like hypothyroidism and diabetes.
Diagnostic methods including physical examinations, maneuvers, and nerve conduction studies.
Management includes wrist braces, vitamin B6, exercises, cortisone injections, and surgical options.
Wrap up and acknowledgment.
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Carpal tunnel syndrome
- 1. Carpal Tunnel SyndromeMargarita Correa MD FAAPMR Physical Medicine and Rehabilitation
- 2. Anatomy Carpus isa word derived from the Greek word "karpos" which means "wrist." The wrist is surrounded by a band of fibrous tissue that normally functions as a support for the joint.
- 3. Anatomy The tightspace between this fibrous band and the wrist bone is called the carpal tunnel. The median nerve passes through the carpal tunnel to receive sensations from the thumb, index, and middle fingers of the hand.
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- 5. Carpal Tunnel SyndromeCarpal tunnel syndrome is pressure on the median nerve -- the nerve in the wrist that supplies feeling and movement to parts of the hand. It can lead to numbness, tingling, weakness, or muscle damage in the hand and fingers.
- 6. Symptoms Numbness ortingling in the thumb and next two or three fingers of one or both hands Numbness or tingling of the palm of the hand Pain extending to the elbow Pain in wrist or hand in one or both hands
- 7. Symptoms Problems withfine finger movements (coordination) in one or both hands Wasting away of the muscle under the thumb (in advanced or long-term cases) Weak grip or difficulty carrying bags (a common complaint) Weakness in one or both hands
- 8. Causes Usually thecause is unknown. Pressure on the nerve can happen several ways: swelling of the lining of the flexor tendons, called tenosynovitis.
- 9. Causes Joint dislocationsFractures Osteoarthritis can narrow the tunnel Posture - keeping the wrist bent for long periods of time Repetitive wrist movements
- 10. Causes Fluid retentionduring pregnancy can cause swelling in the tunnel and symptoms of carpal tunnel syndrome, which often go away after delivery. Thyroid conditions (hypothyroidism) Rheumatoid arthritis Diabetes mellitus
- 11. Causes Women are three times as likely as men are to develop carpal tunnel syndrome, according to the National Institute of Neurological Disorders and Stroke. Heredity: You may be significantly more likely to develop carpal tunnel syndrome if close relatives have had the condition. Inherited physical characteristics, such as the shape of your wrist, may make you more susceptible.
- 12. Diagnosis History PhysicalExamination: Tinel sign: is a way to detect irritated nerves. It is performed by lightly tapping (percussing) over the nerve to elicit a sensation of tingling or "pins and needles" in the distribution of the nerve
- 13. Diagnosis Phalen's maneuver is a diagnostic test for carpal tunnel syndrome discovered by an American orthopedist named George S Phalen.
- 14. Diagnosis Atrophy ofthe thenar eminence – severe cases Abductor pollicis brevis Flexor pollicis brevis Opponens pollicis
- 15. Diagnosis Nerve ConductionStudies Prolongation of the distal latencies of the median motor and sensory evoked potentials Excludes peripheral neuropathy and other nerves lesions
- 16. Diagnosis Electromyography – evaluates the electrical impulses from the muscle fibers Excludes cervical radiculopathy Denervation potentials on the muscles supplied by the median nerve – criteria for surgical decompression
- 17. Treatment The goalof treatment for CTS is to reduce the swelling and pressure on the median nerve. Wrist brace Avoid inadequate posture and repetitive wrist movement
- 18. Ergonomics Keyboard andmouse support
- 19. Treatment Vitamin B6 (Pyridoxine) - 200mg po daily for 90 days – may relieve numbness and tingling
- 20. Treatment Median NerveGliding Exercises
- 21. Median Nerve GlidingExercises
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- 23. Cold Laser TherapyLow level laser therapy (LLLT): The exact mechanism of its effect on carpal tunnel and other pain syndromes is unknown; hypotheses have included improved cellular repair and stimulation of the immune, lymphatic, and vascular systems.
- 24. Local Cortisone InjectionCorticosteroids and Lidocaine (local anesthetic) can be injected directly into the wrist
- 25. Treatment Oral cortisoneusually medrol dosepack The local injection and oral cortisone are used to relieve pressure (inflammation) on the median nerve and provide immediate, temporary relief to persons with mild or intermittent symptoms.
- 26. Surgery Open CarpalTunnel Release
- 27. Surgery Endoscopiccarpal tunnel release – minimal invasive
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- 29. Rehabilitation after SurgeryGentle massage for the scar tissue -desensitize the incision Modalities to decrease pain, inflammation and swelling (heat, cold, e-stim) Progressively exercises to strengthen and stabilize the muscles and joints in the hand. Exercises to improve fine motor control and dexterity.
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