Tunnel Syndrome CatsTCMNotes腕管综合征 ppt课件.ppt

Carpal Tunnel Syndrome Hand/Finger/Wrist Issues Presentation: A 64-year-old, right-handed, retired woman presents with: intermittent numbness, tingling, and burning pain Location: The three radial digits of both hands Duration: Had these symptoms for three months History: These symptoms awaken her several times each night. On examination: She has no atrophy of the thenar muscles. Sensation to light touch is intact. How should she be evaluated and treated? Scope of the problem 2.7 million office visits Differential diagnosis: Entrapments of the nerves- Carpal tunnel syndrome, Entrapment of the ulnar nerve Cervical radiculopathy Tendon disorders, Overuse of muscles, Nonspecific pain syndromes CT Anatomy CTS Data F: 3%, M:2%, Average age: 55 yrs Elevated pressure in the carpal tunnel Results in ischemia of the median nerve Causes impaired nerve conduction and attendant paresthesia and pain Related Conditions: Pregnancy Inflammatory arthritis- RA Colles’ fracture Amyloidosis Hypothyroidism Diabetes mellitus 6% Acromegaly Use of corticosteroids and estrogens CTS: Occupational Repetitive activities of the hand and wrist particularly with a combination of forceful and repetitive activities: Food processing Manufacturing Logging Construction work Data entry History Pain, tingling, burning, numbness, or some combination of these symptoms on the palmar aspect of the thumb, index finger, middle finger, and radial half of the ring finger No such symptoms affect the fifth finger Nocturnal symptoms reported (51-77%) “Flick Sign”: Shake the symptomatic hand or hands when symptoms are at their worst gives relief Assessment Late signs: Loss of two-point discrimination in the median nerve distribution Thenar atrophy Phalen’s maneuver: Flexion of the wrist for 60 seconds elicits pain or paresthesia in the median-nerve distribution (40-80%) Tinel’s sign: Present if tapping lightly over the volar surface of the wri