Carpal tunnel syndrome

carpal tunnel sindrom merupakan neuropati perifer fokal yang paling umum terjadi yang
merupakan kompresi saraf median di pergelangan tangan.
Clinical Features
Nyeri
Mati rasa
Kesemutan
Gejala biasanya lebih buruk di malam hari dan dapat membangunkan pasien dari tidur.
Untuk meredakan gejalanya, pasien sering "mengibaskan" pergelangan tangan mereka
seolah-olah mengguncang termometer (tanda flick).
Nyeri dan parestesia dapat menjalar ke lengan, siku, dan bahu.
Kekuatan genggaman yang berkurang dapat menyebabkan hilangnya ketangkasan, dan
atrofi otot tenar dapat terjadi jika sindrom sudah parah.
Physical examination
Phalen’s maneuver

Tinel’s sign

weak thumb abduction.

 two-point discrimination

Diagnostic
History
Physical examination
Nerve Conduction Study
Differential Diagnostics
Tendonitis
Tenosynovitis
Diabetic neuropathy
Kienbock's disease
Compression of the Median nerve at the elbow
Treatment
Conservative treatments
General measures
a. Avoid repetitive wrist and hand motions that may exacerbate symptoms or
make symptom relief difficult to achieve.
b. Not use vibratory tools
c. Ergonomic measures to relieve symptoms depending on the motion that
needs to be minimized
Wrist splints
Probably most effective when it is applied within three months of the onset of
symptoms

Oral medications
a. Diuretics
b. Nonsteroidal anti-inflammatory drugs (NSAIDs)
c. pyridoxine (vitamin B6)
d. Orally administered corticosteroids
a. Prednisolone
b. 20 mg per day for two weeks
c. followed by 10 mg per day for two weeks
Local injection
A mixture of 10 to 20 mg of lidocaine (Xylocaine) without epinephrine
and 20 to 40 mg of methylprednisolone acetate (Depo-Medrol) or similar
corticosteroid preparation is injected with a 25-gauge needle at the distal wrist
crease (or 1 cm proximal to it).
 Ultrasound therapy
Predicting the outcome of conservative treatment
Surgery
Should be considered in patients with symptoms that do not respond to conservative
measures and in patients with severe nerve entrapment as evidenced by nerve conduction
studies,thenar atrophy, or motor weakness. It is important to note that surgery may be
effective even if a patient has normal nerve conduction studies

Complications of surgery
1. Injury to the palmar cutaneous or recurrent motor branch of the median nerve
2. Hypertrophic scarring
3. laceration of the superficial palmar arch
4. tendon adhesion
5. Postoperative infection
 6. Hematoma
7. arterial injury
8. stiffness

wipperman, jennifer and kyle goerl university of kansas school of medicine–wichita, wichita, kansas.
am fam physician. 2016 dec 15;94(12):993-999.