Carpal tunnel syndrome is a compressive neuropathy of the median nerve as it passes through the carpal tunnel in the wrist. It commonly affects the general population, with risk factors including female sex, obesity, pregnancy, rheumatoid arthritis, and repetitive motions. Symptoms include numbness and tingling in the thumb, index, middle and half of ring fingers, especially awakening the patient at night. Diagnosis involves physical exam findings like thenar atrophy and positive Tinel's and Phalen's tests. Conservative treatment includes splinting, activity modification, and steroid injections, while surgery involves carpal tunnel release if conservative measures fail.

1. RE
BAGIAN ORTOPEDI &TRAUMATOLOGI FAKULTAS KEDOKTERAN UNHAS MAKASSAR

2.  Most common compressive neuropathy
 pathologic (inflamed) synovium most
common cause of idiopathic CTS

3.  affects 0.1-10% of general population
 risk factors
 female sex
 obesity
 pregnancy
 hypothyroidism
 rheumatoid arthritis
 advanced age
 chronic renal failure
 smoking
 alcoholism
 repetitive motion activities
 mucopolysaccharidosis
 mucolipidosis

4.  precipitated by
▪ exposure to repetitive motions and vibrations
▪ certain athletic activities
▪ cycling
▪ tennis
▪ throwing
 pathoantomy
 compression may be due to
▪ repetitive motions in a patient with normal anatomy
▪ space occupying lesions (e.g., gout)

5.  good prognostic indicators include
 night symptoms
 short incisions
 relief of symptoms with steroid injections
 not improved when incomplete release of
transverse carpal ligament is discovered

7.  Carpal tunnel defined by
 scaphoid tubercle and trapezium radially
 hook of hamate and pisiform ulnarly
 transverse carpal ligament palmarly (roof)
 proximal carpal row dorsally (floor)

8.  Carpal tunnel consists of
 nine flexor tendons
 one nerve (median nerve)
 FPL is the most radial structure

9.  Symptoms numbness and tingling in radial 3-
1/2 digits
 clumsiness
 pain and paresthesias that awaken patient at
night
 self administered hand diagram
 the most specific test (76%) for carpal tunnel
syndrome

10.  thenar atrophy
 Durkan's test
 Phalen test
 Tinel's test
 Semmes-Weinstein testing
 innervation density test

11.  numbness and tingling in the median nerve
distribution
 nocturnal numbness
 weakness and/or atrophy of the thenar
musculature
 positiveTinel sign
 positive Phalen test
 loss of two point discrimination

12.  NSAIDS, night splints, activity modifications
 steroid injections
 indications
▪ adjunctive conservative treatment
▪ diagnostic utility in clinically and electromyographically equivocal cases
 outcomes
▪ 80% have transient improvement of symptoms (of these 22% remain
symptoms free at one year)
▪ failure to improve after injection is poor prognostic factor
▪ surgery is less effective in these patients
▪ 25% will have no relief

13.  carpal tunnel release
 indications
▪ failure of nonoperative treatment (including steroid injections)
▪ acute CTS followingORIF of a distal radius fx
 outcomes
▪ pinch strength return in 6 week
▪ grip strength is expected to return to 100% preoperative levels
by 12 weeks postop
▪ rate of continued symptoms at 1+ year is 2% in moderate and 20%
in severe CTS