Carpal tunnel syndrome CTS 2014


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Carpal tunnel syndrome (CTS) is a median entrapment neuropathy that causes paresthesia, pain and numbness in the distribution of the median nerve. The pathophysiology can be considered compression of the median nerve travelling through the carpal tunnel.

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Carpal tunnel syndrome CTS 2014

  1. 1. Dr Saber Lahmidi
  2. 2.  is a painful condition of the hand and fingers caused by excessive pressure on the median nerve at the front of the wrist
  3. 3. The carpal tunnel is a narrow passageway on the palm side of your wrist made up of bones and ligaments. The median nerve, which controls sensation and movement in the thumb and first three fingers, runs through this passageway along with tendons to the fingers and thumb. When it's pinched or compressed, the result is numbness, tingling, weakness, or pain in the hand, called carpal tunnel syndrome.
  4. 4. The carpal tunnel is located on the palm side of the wrist. The floor and sides of the carpal tunnel are formed by the eight wrist bones and the roof of the tunnel is a tough piece of fibrous tissue, called the transverse carpal ligament.
  5. 5.  Caused by frequent or repetitive tasks.  Improper use, or improper position of the wrists during typing.
  6. 6. Anyone doing repetitive work with their hands, in particular those using computer keyboards.
  7. 7.  Numbness, tingling and pain in the thumb, index and middle finger.  As symptoms worsen, people may find it difficult to close the hand into a fist, grasp small objects, or perform other manual tasks with their hands.  They may also feel increased tingling during the day and a marked decrease in the strength of their grip.
  8. 8. to notice weakness in your thumb and first two, and it may be difficult to make a fist or grasp objects. You may find yourself dropping things, or you may have trouble doing things
  9. 9. Some people feel like their fingers are swollen, or they may have trouble distinguishing between hot and cold.
  10. 10. There usually isn't one definitive cause of carpal tunnel syndrome. Because the carpal tunnel is narrow and rigid, anytime there is swelling or inflammation in the area, the median nerve can be compressed and cause pain. Symptoms may be present in one or both hands (usually symptoms develop in the dominant hand first).
  11. 11. -Women are 3 times more likely than men to get CTS. Certain conditions can also increase your risk. These include: -Diabetes -Gout -Hypothyroidism -Rheumatoid arthritis -Pregnancy -Sprain or fracture of the wrist
  12. 12. At first, symptoms of CTS come and go, but as the condition worsens, symptoms may become constant. Pain may radiate up the arm all the way to the shoulder. Over time, if untreated, CTS can cause the muscles on the thumb side of your hand to waste away (atrophy).
  13. 13. The Tinel test involves tapping on the median nerve to see if it causes tingling in the fingers. Phalen test; the doctor will have you press the backs of your hands together for a minute to see if this causes numbness or tingling.
  14. 14. -To confirm the diagnosis (a nerve conduction study) -Electromyography, uses a fine needle inserted into a muscle to measure electrical activity and assess damage to the median nerve.
  15. 15. Advise resting the hand and wrist and wearing a brace to limit movement. Non-steroidal anti-inflammatory drugs NSAIDs such as ibuprofen and naproxen, along with cold compresses, can reduce pain.
  16. 16. -Corticosteroids -Steroids can temporarily reduce inflammation around the median nerve. -Injection of a local anesthetic (lidocaine) can also relieve symptoms. -Other things that may help include diuretics. -Vitamin B6 supplements.
  17. 17. If surgery is needed, it's typically done on an outpatient basis under local anesthesia. The ligament overlying the top of the carpal tunnel is cut to relieve pressure. The healed ligament will allow more space in the carpal tunnel.
  18. 18. Sometimes the procedure is done endoscopically, using a tiny camera inserted through a very small incision to guide the procedure.
  19. 19. There may be some swelling and stiffness right after surgery, which can be relieved by elevating hand over heart and moving fingers frequently. To wear a wrist brace for a few weeks while you heal, but will still be able to use your hands. Pain and weakness usually resolve within two months after surgery, but it may take 6 months to a year to recover completely.
  20. 20. •Good posture •Ergonomic tools and workstations •Stretching hands and wrists regularly •Taking frequent rest breaks to shake arms and legs, lean back •Change position throughout the work day