Diseases of hand

1. BVVS HOMOEOPATHIC MEDICAL COLLEGE AND
HOSPITAL,BAGALKOT.
SEMINARPRESENTATION
TOPIC: Carpal Tunnel Syndrome & Ganglion
Guided By:
Dr.Pradeep.Reddy Sir
Presented By:
Arjun.M

2. CARPAL TUNNEL SYNDROME
• Defination:
• CTS is the most common focal peripheral neuropathy,results from
compression of median nerve at the wrist.
• It can lead to numbness,tingling,weakness,or muscle damage in hand
and fingers.

3. ANATOMY
• Carpus is a word derived from the
Greek word “karpos” which means
“wrist”.
• The wrist is surrounded by a band of
fibrous tissue that normally functions
as support for the joint.
• The tight space between the fibrous
band and wrist bone is called carpal
tunnel.

4. Cont,,
• The median nerve passes through the
carpal tunnel to receive sensations
from thumb, index,and middle fingers
of the hand.

5. CAUSES for CTS
• Joint dislocations,i.e., lunate dislocation.
• Fractures,i.e., malunited colle’s fracture.
• Radiocarpal arthritis.
• Flexor tendon tenosynovitis.
• Myxoedema and acromegaly.
• Posture- keeping the wrist bent for longer time.
• Repetitive wrist movements.

6. CAUSES cont,,
• Pregnancy-fluid retention during pregnancy can cause swelling in the
tunnel and symptoms of CTS,which often go away after delivery.
• Rheumatoid arthritis.

7. FEATURES
• Common in females.
• Condition is often bilateral.
• Tingling , numbness, paraesthesia and burning sensation in the lateral
three and half fingers supplied by median nerve.
• Burning sensation gets aggravates at night.
• Features of low median nerve palsy i.e..thumb deformity ,wasting of
thenar muscles,and weakness of muscles.
• When BP cuff is inflated patient feels the typical pain in the fingers.
• Phalen’s test (wrist flexion test) is positive.

8. SIGNS AND SYMPTOMS
• Tingling
• Numbness in the lateral three and
half fingers.
• Intermittent pain in the distribution
of median nerve.
• Symptoms get aggravated at night.

9. CONT,,
• MOTOR CHANGES:
> Apelike thumb deformity.
> Loss of opposition of thumb.
> Index and middle finger lag behind when
making fist.

10. CONT,,
• SENSORY CHANGES:
>Loss of sensation of lateral 3 ½ digots including the nail bed and
distal phalanges on dorsum of hand.
VASOMOTOR CHANGES:
> Skin area with sensory loss is warmer
> dry skin
TROPHIC CHANGES:
>Nails crack easily
>Atropy of pulp of fingers

11. DAIGNOSIS
Physical assessment test:
• Less sensitivity to pain where the median nrve runs to fingers.
• Thumb weakness.
• Inability to tell the difference between one and two sharp points on
fingertips.

12. Phalen’s test
- The patient rest the elbows on the table.
- The wrist flexion with fingers pointing down and backs of the hands
pressed together.
POSITIVE : If symptoms devolops within a minute , CTS is indicated.

13. Tinel’s sign test:
• In the Tinel’s sign test, the doctor taps over the median nerve to
produce a tingling or mild shock sensation.

14. • Durkan test:
The doctor presses over the carpal tunnel for 30 seconds to
produce tingling or shock in median nerve.
• Hand elevation test:
The patient raises his or her hand overhead for 2 minutes to
produce symptoms of CTS.
• Nerve conduction studies and,
• Electromyography.

15. TREATMENT
• Medical line of treatment:
- Oral cortisones usually MEDROL Dosepacks.
- Oral cortisones and local injections are used to relieve
pressure(inflammation) on the median nerve and provide immediate
and temporary relief to persons with mild or intermittent symptoms.

16. • Local cortisone injections:
- Corticosteroids and lidocaine(local anesthetic) can be injected
- directly into the wrist.

17. • Conservative line of treatment:
> Wrist brace
> Avoid inadequate posture and repitative wrist movement.
> Keyboard and mouse support.

18. Cont,,
• Median nerve gliding exercise.
• Carpal Tunnel Stretch.

19. • Surgical line of treatment:
OCPR –Open Carpal Tunnel Release

20. • ECTR: Endoscopic Carpal Tunnel Release

21. HOMOEOPATHIC REMEDIES
• CAUSTICUM
- Weakness in hands , numbness, and pain in the fingers.
- It is more indicated in when CTS has increased to a level where is
an excessive weakness in hands.
- Muscles of hand have atrophied.
- Causticum is indicated in case of CTS if palmer side of hand has flat
appearance.
• RUTA
-CTS from overuse of wrist.
-Indicated in tendonitis or wrist fractures.

22. • HYPERICUM:
- Damaging to the median nerve triggers the CTS.
- Indicated in nerve injury.
- Indicated in numbness , tingling and burning pain in fingers and
hand.
• ARNICA:
- This medicine is useful in managing cases of CTS from injury or
overuse of wrist.
-It is suitable when there is pain in hands.
- Also indicated in tingling in hands and arms.

23. • RHUS TOX:
- Rhus tox is very effective when CTS is caused by overuse of wrist .
- And also CTS is caused by wrist joint inflammation (arthritis).
- This medicine is indicated in pain and tenderness in the wrist.
- Any pressure exerted on the wrist is unbearable.
- Numbness in fingers especially index and middle fingers in morning.
• BELLIS PERENNIS:
- CTS from repetitive strain injury.
- Indicated when contracted feeling in the wrist.
- Feels as if there is an elastic band around the wrist contracting it.

24. GANGLION CYST

25. INTRODUCTION
• Ganglion
- Ganglion is a localized,tense cystic swelling in connection with the
joint capsule or tendon sheaths. It contains clear gelatinous fluid.
• Also known as Bible cyst.
• Common in women,and 70% occur in people between the ages of
20-40yrs.
• Rarely, ganglion cyst can occur in children younger than 10 yrs.

27. AETIOLOGY
• The cause of ganglion cyst is unknown.
• Synovial herniation.
• Mucus cyst formation.
• Myxoid degeneration of fibrous tisse of capsule,ligaments and
retinaculae of the joint.
• According to some,ganglion arises from small bursa within the
substance of the joint capsule or the fibrous tendon sheath.
• Ganglion sometimes initiated or excited by injury.

28. SITES OF GANGLION CYST
• Dorsum of the wrist.
• Front of the wrist.
• The dorsum of foot.
• Palmer aspect of the hand.
• The flexor aspects of fingers.

29. CLINICAL FEATURES
• Common in females.
• Size show variation with time.
• Intermittantly painful,following repetative trauma.
• Pain ,worse on joint motion.
• When cyst is connected to a tendon,weakness in the affected finger.

30. • ON EXAMINATION:
INSPECTION
- Swelling on the dorsum of wrist(somrtimes on volar aspects) .
- Pea size (occasionally larger).
• PALPATION
- Very firm/ bony hard.
- Wrist ROM is normal.
• Mobility:
- Mobility is not much, though it can be moved with great difficulty sideways.
- It is immobile along the axis of the tendon.

31. INVESTIGATIONS
• Ultrasonography:
-To determine whether the bump is fluid –filled or if it is solid.
-to detect whether an artery or blood vessels causing the lump.
• MRI
-To see the wrist.
• Refer to the hand surgeon.

32. MANAGEMENT
• >CONSERVATIVE
- Observation.
- Closed rupture.
- Cyst puncture.
- Aspiration
• > SURGICAL
-Excision.

33. HOMOEOPATHIC REMEDIES
• RUTA
• > The cyst may be present on the wrist,hand and fingers.
• > The ganglion tend to interfere with joint movement of wrist.
• > Numbness in the hands may be present along with pain in wrist joint.
• > Numbness and tingling in the hands after the exercise most of the time.
• > History of injury to tendon or joint.
• RHUS TOX
• > Rhus tox is very suitable for managing pain in wrist in cases of ganglion cyst.
• > The pain tends to get worse during rest,and also worsen by cold,and in some
cases bending the wrist also tend to worsen the pain.
• > Motion relieves the pain in wrist in most cases rhus tox is indicated.
• > Pain of drawing nature in palm of hand along with numbness and burning sensation in hand.

34. • RHODODENDRON
• > Rhododendron is another medicine for managing wrist pain in ganglion cyst.
• > Drawing and tearing pain in wrist.
• > The pain may get worse in the evening time.
• > Rest also worsen the pain.
• > Heated sensation in the hands may be present occasionally.
• SILICEA
• > Ganglion cyst on left side of the wrist.
• > The cyst is located on extensor surface of wrist.
• > Tearing and stitching type of pain and numbness in hand.
• CALCAREA CARB- ganglion cyst on the right side of wrist.
• ARNICA-Ganglion cyst with history of wrist injury.