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SURGERY

Ortho

QuestionAnswer
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