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SURGERY
Ortho
| Question | Answer |
|---|---|
| Carpal tunnel syndrome - what is the mechanism of the disorder? | compression of the median nerve |
| what is the distribution of median nerve innervation? | palmar side of thumb, index finger, middle finger and medial half of ring finger; dorsal tips of said fingers |
| Carpal tunnel syndrome - tx (5) | nighttime splint, avoidance of activity, NSAIDs, local steroid injections (not more frequently than 2-3 per year - don't inject INTO median nerve), surgery if refractory to medical man or severe pain/progressive motor weakness despite conservative tx |
| typical sx's of Carpal tunnel syndrome | pain and numbness of radial fingers and sometimes hand weakness; worse at night; thenar muscle wasting, decreased abductor muscle resistance, motor loss. |
| Tinel sign | reproduction of pt's sx's by percussion of the median nerve at the wrist; diagnosis of CTS is clinical |
| What test is used for diagnosis of CTS? | electrophysiologic studies - investigate nerve conduction and muscle innervation |
| Carpal tunnel syndrome - why is there exacerbation of sx's at night? | edema and tenosynovitis (inflammation of the lining of the sheath that surrounds a tendon) |
| Carpal tunnel syndrome is associated with which other conditions? | DM, myxedema, hyper/hypothyroidism, acromegaly, pregnancy, autoimmune d/o, lipomas of the canal, bone abnl, hematomas |
| What gender is more likely to get Carpal tunnel syndrome? | females 3:1 |
| Carpal tunnel syndrome - more likely to be uni or BL? | BL in 50% of pts so comparison to contralateral hand can be misleading |
| What mode of imaging has greatest sensitivity and specificity for diagnosing carpal tunnel syndrome? | MRI |
| Describe the surgery for carpal tunnel release surgery and f/u | open or endoscopic --> tourniquet to exsanguinate limb--> fascia and transverse carpal ligament are divided proximal to distal --> small tissue flap is left attached to hamate; wrist splinted in slight extension for 2 wks |
Created by:
christinapham
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