Treatment for Carpal tunnel syndrome

Carpal Tunnel Syndrome

Bismillahirahmanirahim ,

Here another hot topic had been asking from my patient and also one of the  

Work-related Musculoskeletal Disorders (WMSDs) 

What is Carpal Tunnel Syndrome

Carpal tunnel syndrome, the most common focal peripheral neuropathy, results from compression of the median nerve at the wrist.

Symptom of CTS

·         Pain + wasting at thenar 

·         Numbness

·         Tingling

·         Symptoms are usually worse at night and can awaken patients from sleep.

·         To relieve the symptoms, patients often “flick” their wrist as if shaking down a thermometer (flick sign).

Physical examination and sign 

·         Phalen’s maneuver

·         Tinel’s sign

·        Hand elevation test .

What are the Type of treatment and management of CTS 

            Prevention measures

·         Avoid repetitive wrist and hand motions that may exacerbate symptoms or make symptom relief difficult to achieve.

·         Not use vibratory tools

·         Ergonomic measures to relieve symptoms depending on the motion that needs to be minimized

           Physiotherapist guideline for CTS

•  Education regarding:

o    changing wrist positions (ie, avoiding prolonged bent wrist positions)

o    proper neck and upper back posture (ie, avoiding forward head or slouching)

o    safe use of sharp utensils, tools, or other implements, if sensory changes are identified

o    "stretch breaks" during your work or daily routine

• Exercises to increase the strength of the muscles in your hand, fingers, and forearm—and in some cases, the trunk and postural back muscles
•  Stretching exercises to improve the flexibility of the wrist, hand, and fingers

•  Use of heat/cold treatments to relieve pain
•  Use of a night splint to reduce discomfort
• A worksite visit to assess your work area. For example, if you sit at a desk and work on a computer, it's important for the keyboard to be in proper alignment to help avoid working in a bent wrist position.
•  Increasing the size of tool and utensil handles by adding extra material for a more comfortable grip
• Anti-vibration gloves or anti-vibration wraps around tool handles, if vibration is a factor at your workplace

Wrist Splint 

·         Probably most effective when it is applied within three months of the onset of symptoms

Exercise for CTS

Local Injection 

·         A mixture of 10 to 20 mg of lidocaine (Xylocaine) without epinephrine and 20 to 40 mg of methylprednisolone acetate (Depo-Medrol) or similar corticosteroid preparation is injected with a 25-gauge needle at the distal wrist crease (or 1 cm proximal to it).

·         Splinting is generally recommended after local corticosteroid injection.

·         If the first injection is successful, a repeat injection can be considered after a few months

·         Surgery should be considered if a patient needs more than two injections

Surgery

·         Should be considered in patients with symptoms that do not respond to conservative measures and in patients with severe nerve entrapment as evidenced by nerve conduction studies,thenar atrophy, or motor weakness.

·         It is important to note that surgery may be effective even if a patient has normal nerve conduction studies

Complications of surgery

·         Injury to the palmar cutaneous or recurrent motor branch of the median nerve

·         Hypertrophic scarring

·         laceration of the superficial palmar arch

·         tendon adhesion

·         Postoperative infection

·         Hematoma

·         arterial injury

·         stiffness

Pregnancy and related with CTS

·         Alterations in fluid balance may predispose some pregnant women to develop carpal tunnel syndrome.

·         Symptoms are typically bilateral and first noted during the third trimester.

·         Conservative measures are appropriate, because symptoms resolve after delivery in most women with pregnancy-related carpal tunnel syndrome

Conclusion

·         Most common focal peripheral neuropathy

·         Pain and paresthesias in the distribution of the median nerve are the classic symptoms.

·         While Tinel’s sign and a positive Phalen’s maneuver are classic clinical signs of the syndrome, hypalgesia and weak thumb abduction are more predictive of abnormal nerve conduction studies.

·         Conservative treatment options include splinting the wrist in a neutral position and ultrasound therapy

·         Orally administered corticosteroids can be effective for short-term management (two to four weeks), but local corticosteroid injections may improve symptoms for a longer period.

·         If symptoms are refractory to conservative measures or if nerve conduction studies show severe entrapment, open or endoscopic carpal tunnel release may be necessary.

wallahuaklam..