Citations 9. View Metrics. History of Neurology: Seminal Citations. May Weinberg, MD. Access through your institution. Add or change institution. Save Preferences. Privacy Policy Terms of Use. Access your subscriptions. The term carpal tunnel syndrome describes a condition that arises when the median nerve, which runs from the forearm into the hand, is compressed at the wrist by a tendinous band.
Compression of this nerve can result in pain, weakness, and numbness involving the wrist and hand mostly involving the thumb, index, middle, and ring fingers. In most cases, no specific etiology can be identified. However, patients who perform repetitive manual tasks such as assembly line work , or construction workers that use vibrating hand tools are at increased risk of developing carpal tunnel syndrome.
The development of carpal tunnel syndrome has been associated with trauma, obesity, pregnancy, multiple myeloma, hypothyroidism and amyloidosis. Symptoms may be bilateral or unilateral.
Patients frequently complain of hand weakness particularly in grip , hand clumsiness and hand numbness. Treatment of carpal tunnel syndrome. Efficacy of a fabricated customized splint and tendon and nerve gliding exercises for the treatment of carpal tunnel syndrome: a randomized controlled trial.
Arch Phys Med Rehabil. Neutral wrist splinting in carpal tunnel syndrome: a comparison of night-only versus full-time wear instructions. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev.
Boyer MI. Corticosteroid injection for carpal tunnel syndrome. J Hand Surg Am. Edinburgh, U. Comparison of needle position proximity to the median nerve in 2 carpal tunnel injection methods: a cadaveric study. Open compared with 2-portal endoscopic carpal tunnel release: a 5-year follow-up of a randomized controlled trial. Surgical versus non-surgical treatment for carpal tunnel syndrome. Return to functional hand use and work following open carpal tunnel surgery. J Hand Surg Br.
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Sign Up Now. Previous: Update on Subclinical Hyperthyroidism. Apr 15, Issue. Carpal Tunnel Syndrome. C 7 , 9 , 10 Neutral and cock-up wrist splints produce short-term symptom relief in persons with carpal tunnel syndrome, with full-time use more effective than night-only use.
B 19 , 20 Local and systemic corticosteroids yield significant resolution of symptoms in mild carpal tunnel syndrome for up to one month. Enlarge Print Table 1. Table 1. Enlarge Print Table 2. Carpal Tunnel Syndrome Differential Diagnosis Condition Characteristics Carpometacarpal arthritis of thumb Joint line pain, pain on motion, radiologic finding Cervical radiculopathy C6 Neck pain, numbness in thumb and index finger only Flexor carpi radialis tenosynovitis Tenderness near base of thumb Median nerve compression at elbow Tenderness at the proximal forearm Raynaud phenomenon History of symptoms related to cold exposure Ulnar or cubital tunnel syndrome First dorsal interosseous weakness, fourth and fifth digit paresthesias Vibration white finger Uses vibrating hand tools at work Volar radial ganglion Mass near base of thumb, above wrist flexion crease Wrist arthritis Limited motion at wrist, radiologic finding.
Table 2. Enlarge Print Figure 1. Median nerve palmar distribution. Figure 1. Enlarge Print Figure 2. Figure 2. Enlarge Print Table 3. Table 3. Enlarge Print Table 4. Table 4. Enlarge Print Figure 3. A neutral wrist splint for carpal tunnel syndrome. Figure 3. Enlarge Print Figure 4. Figure 4. Enlarge Print Table 5.
Recommended Technique for Corticosteroid Injection in Patients with Carpal Tunnel Syndrome Place patient in a seated or supine position, with forearm in supination and wrist slightly extended Identify point medial to the palmaris longus tendon or midway between the palmaris longus and flexor carpi ulnaris tendons Insert a gauge needle 1 cm proximal to the most distal wrist crease Direct the needle in a degree angle; slide distally until needle end lies under midpoint of the retinaculum Give as a slow bolus injection; if patient has pain or paresthesias, stop the injection and redirect the needle medially Advise patient to actively move his or her fingers for several minutes to allow even distribution of the solution.
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Navigate this Article. Carpometacarpal arthritis of thumb. Joint line pain, pain on motion, radiologic finding. Cervical radiculopathy C6. Neck pain, numbness in thumb and index finger only. Flexor carpi radialis tenosynovitis. Tenderness near base of thumb. Median nerve compression at elbow.
Tenderness at the proximal forearm. History of symptoms related to cold exposure. Ulnar or cubital tunnel syndrome. First dorsal interosseous weakness, fourth and fifth digit paresthesias. Vibration white finger.
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