Carpal Tunnel Syndrome

Published on 23/06/2015 by admin

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Last modified 23/06/2015

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Chapter 154 Carpal Tunnel Syndrome

image General Considerations

Carpal tunnel syndrome (CTS) involves compression of the median nerve in the carpal tunnel. Sensory impairment occurs in the first three digits and the lateral one half of the fourth digit of the hand. Pain may be felt in the palm, anterior wrist, forearm, and proximally to the shoulder. Loss of fine motor skills and strength in abduction and opposition of the thumb may develop. Atrophy of the opponens pollicis muscle may occur.1

Risk Factors and Frequency of Occurrence

CTS most often occurs after age 30 and women are affected three times as often as men.4 Repetitive strain injury (RSI) from light duty work as a cause of CTS is not well supported by the current literature.5 However, a study of 501 participants, 156 of whom were diagnosed with CTS, showed the following risk factors: repetitive activities with a flexed or extended wrist, hysterectomy without oophorectomy, and menopausal women who had their last menstrual period 6 to 12 months earlier.6 Others report increased the incidence of CTS due to pregnancy, hypothyroidism, diabetes, and recent menopause.7

image Diagnostic Considerations

There is no single reference standard for diagnosis of the syndrome; a combination of symptoms, signs, and tests should be used to characterize the disorder.1

Other Diagnostic Tests

The carpal compression test, when the examiner exerts direct compression with the thumbs over the patient’s carpal tunnel for 30 seconds and reproduces the symptoms, was reported as having 89% sensitivity and 96% specificity when performed with the Durkan guage.9 Other studies have not reproduced these findings but have reported “Tinel’s, Phalen’s, Reverse Phalen’s, and carpal tunnel compression tests are more sensitive, as well as being specific tests for the diagnosis of tenosynovitis of the flexor muscles of the hand, rather than being specific tests for CTS.”34,35 Weakness of the thumb abductor muscle is a strong indication to order neurophysiologic testing (nerve conduction studies [NCS] and/or electromyography). In CTS, NCS may show motor and sensory latencies across the wrist.

Magnetic resonance imaging (MRI) and high-definition ultrasound imaging can measure the dimensions of the carpal tunnel and size of the median nerve, but these tests are expensive and not needed in uncomplicated CTS.

image Differential Diagnosis

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