What is a Carpal Tunnel Syndrome?

a

@ CTS is compression of the median nerve at the
wrist, which may result in numbness, tingling,
weakness, or muscle damage in the hand and
fingers.
@ CTS is an entrapment neuropathy that occurs
when the median nerve at the wrist is compressed
by a thickened flexor tendon sheath, skeletal
encroachment, edema or soft tissue mass.
 V 
V

  n t r a p me n t Neuropathy

 Median Nerve Dysfunction

 Ú
V V
@ nflammation of the flexor
tendon sheath caused by
activities involving repetitive
wrist flexion.
xamples:
-Assembly packing
-Computer keyboard work
-Playing a musical
instrument
-Craftwork
@ dema from trauma of any
type (eg, fractures), which
can compress the median
nerve
@ Strong association between
being overweight or obese
and the presence of CTS
@ Acromegaly
@ Rheumatoid arthritis
@ Gout or pseudo gout
@ Tuberculosis
@ Renal failure and
hemodialysis
@ Hypothyroidism
@ Amyloidosis
@ Has been associated with
diabetes mellitus
 aVV
Ú V
@ Ôamily history may have a significant role in individuals
susceptibility
@ Trauma related; fractures one of the arm bones (Colles Ôracture)
@ Dislocation if the carpal bone on the wrist
@ Pregnancy and hypothyroidism, fluid is retained in tissues which
swells the tenosynovium
@ Acromegaly, disorder of the growth hormones
@ Tumors such as ganglion or lymphoma
@ Common activities identified as repetitive stress induced CTS
includes:
± Computer keyboarding or typing
± Playing video or computer games
± Playing musical instrument
± Construction workers
]A feature of a variety of conditions of carpal
tunnel syndrome (CTS) is caused by compression
of the median nerve in the narrow tunnel formed
by the small bones of the hand, multiple
longitudinal flexor tendons, and the transverse
carpal ligament. Repeated use of the hands may
cause inflammation of these tendons and may lead
to swelling in the wrist and subsequent pressure on
the nerve. Nerve entrapment syndromes result from
focal injury to a peripheral nerve and are more
common in the upper extremities. The most
common entrapment neuropathy is CTS, which
affects the wrist.
 V aV

V
@ Symptoms usually start gradually, with frequent
burning, tingling, or itching numbness in the palm
of the hand and the fingers, especially the thumb
and the index and middle fingers.
@ Ôirst appear in one or both hands during the night,
since many people sleep with flexed wrists.
@ Decreased grip strength may make it difficult to
form a fist, grasp small objects, or perform other
manual tasks.
@ Some are unable to tell between hot and cold by
touch.
a
  
@ 



The patient is asked to
hold their wrist in
complete and forced
flexion (pushing the
dorsal surfaces of both
hands together) for
30±60 seconds.

http://www.webmd.com/painmanagement/carpal
-tunnel/carpal-tunnel-syndrome-exams-and-testst
 

@ s a way to detect
irritated nerves. t is
performed by lightly
tapping over the nerve
to elicit a sensation of
tingling or "pins and
needles" in the
distribution of the
nerve
http://www.webmd.com/painmanagement/carpal-
tunnel/carpal-tunnel-syndrome-exams-and-testst
 
  

@ To evaluate any loss of

normal functioning in the
median nerve. Nerve
testing for carpal tunnel
syndrome is used in
specific situations, such as
when surgery is being
considered or the
diagnosis is unclear.

http://www.webmd.com/painmanagement/carpal-
tunnel/carpal-tunnel-syndrome-exams-and-testst
 ^


m To check for bone
problems caused by past
injury, arthritis, recently
broken or dislocated
bones, or tumors. X-rays
are not used to diagnose
carpal tunnel syndrome,
but they can be helpful for
identifying signs of
arthritis or an old or new
wrist or neck injury that
may be contributing to
your symptoms.
http://www.webmd.com/painmanagement/carpal-
tunnel/carpal-tunnel-syndrome-exams-and-testst
 3


m To look at the size of

the median nerve. t is
inexpensive,
comfortable, and
quick. However, its
use for carpal tunnel
syndrome diagnosis is
still unproven and
relatively uncommon.
http://www.webmd.com/painmanagement/carpal-
tunnel/carpal-tunnel-syndrome-exams-and-testst

 

MDCAL / PHARMACOLOGC
@ Nsaid¶s (Non-Steroidal nflammatory Drugs)
@ examples: buprofen, Naproxen,
@ Carpal canal cortisone injections may relieve the
symptoms
@ Prednisone (oral steroid)
@ Tylenol ; anti-inflammatory
@ Diuretics useful during pregnancy
 V
Ú 

@ Traditional open nerve release/

open method

@ ndoscopic laser surgery- has a

small incision
3   
 
]Hot and cold compress
]Avoid repetitive flexion of the wrist
]Wrist splint to prevent hyperextension
]Relaxing and resting the affected area
]Mild analgesics
]Perform range of motion exercises
]After surgery, monitor vital signs, and regularly
check the color, sensation, and motion of the
affected hand
]
RNR AND S
DDARTS MD-S
RG.NSG.
VOL.2; 11TH
]http://www.webmd.com/painmanagement/carpal-
tunnel/carpal-tunnel-syndrome-exams-and-testst