CARPAL TUNNEL SYNDROME

Carpal Tunnel SyndromeMost common peripheral compression neuropathyFirst reported by Sir James Paget in 1854

CTSCarpal tunnel is formed by the scaphoid tubercle and trapezium on the radial side, and the pisiform and hook of the hamate on the ulnar side

10 Structures Pass Through the Carpal TunnelMedian nerve, FPL, and the eight flexor tendons to the four fingers

Etiology Local anatomy Palmaris profundus Persistent median artery Trauma Cysts, Tumors

Etiology Cont. Systemic or physiologic disorders Diabetes, RA, thyroid disease Alcoholism Pregnancy/Menopause Repetitive use ? W>M; smaller carpal tunnel

Clinical PresentationWeakness or clumsiness of the hands; dominant handBurning, tingling, and numbness in the thumb, index, and long fingers (median nerve)Nighttime numbness

Presentation cont.Forearm and wrist pain; shoulder pain??Symptom aggravation with activityNighttime numbness symptoms improvement with shaking out the hands

DiagnosisHistory+Tinnels test????+Phalens test+Median nerve compression testSensory changes in the median nerve distribution; motor deficits??EMG/NCV???

TreatmentGoal: functional patientTreat underlying cause, if identifiedBased on signs and symptomsConservative: Neutral wrist splint (nighttime, work), NSAIDS, steroid injection, avoid aggravating activities???PT????Surgery

Surgery Indications/ReferralConservative treatment failureThenar atrophyProgressive neurologic changes (motor, sensory)Constant numbness, tingling (axontomesis)

Proximal Phalanx FracturesORIF for transverse & displaced (?)ORIF intraarticular fractures (?)

Interphalangeal Joint FracturesNonoperative treatment usually

Distal Phalanx FracturesTaping usually adequateHard shoeFractures of the Great Toe