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Carpal Tunnel Syndrome: Anatomy, Pathogenesis, Symptoms, Diagnosis, and Treatment, Study Guides, Projects, Research of Mathematical logic

Ramapo College of New Jersey (RCNJ)Mathematical logic

An in-depth analysis of carpal tunnel syndrome (cts), including its anatomy, nerve supply, pathogenesis, symptoms, diagnosis, and treatment. It covers topics such as the anatomy of the hand and nerve supply, the anatomy and pathogenesis of cts, signs and symptoms, tests and investigations, causes, and principles of treatment. It also discusses risk factors and complications.

What you will learn

  • What is the pathogenesis and pathophysiology of Carpal Tunnel Syndrome?
  • What are the symptoms of Carpal Tunnel Syndrome?
  • What diagnostic tests are used to diagnose Carpal Tunnel Syndrome?

Typology: Study Guides, Projects, Research

2017/2018

Uploaded on 04/11/2018

syimah-umar
syimah-umar 🇲🇾

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BLOCK4-PBL5 : CARPAL TUNNEL SYNDROME
BIOLOGICAL
1. Anatomy of hand and nerve supply (incl nerve injury of hand)
2. Anatomy of Carpal Tunnel Syndrome
3. Pathogenesis and pathophysiology of CTS
Median nerve microcirculation injury
Ischemic vascular injury and the breakdown in the blood-nerve barrier have also been identified
as an essential component in CTS. The blood-nerve-barrier is formed by the inner cells of the
perineurium and the endothelial cells of endoneurial capillaries that accompany the median nerve
through the carpal tunnel. These endoneurial microvessels are formed from nutrient branches that
arise from the radial and ulnar arteries, proximal to the flexor retinaculum. An increase in pressure
within the tunnel can cause a breakdown of vasculature within this barrier, causing an
accumulation of proteins and inflammatory cells. This may induce a miniature closed
compartment syndrome by increasing the permeability, contributing to increased endoneurial fluid
pressure and development of an intra-fascicular edema. Patients with vascular problems or
prolonged exposure to static loading are particularly prone to a breakdown in the blood-nerve-
barrier.
Pain- irritation of nerve
Tingling and numbness – CTS pt affect medial nerve sensory innervation
Vasodilation and stasis of movement during sleep so it shows symptoms during morning and
sleep.
4. Pharmacology of NSAIDs
NSAIDs work on a chemical level. They block the effects of special enzymes -- specifically
Cox-1 and Cox-2 enzymes. These enzymes play a key role in making prostaglandins.
Contributor to inflammatory process. By blocking the Cox enzymes, NSAIDs stop your body
from making as many prostaglandins. This means less swelling and less pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs) may relieve pain and inflammation and are
available with or without a prescription. They work best if your tendon is inflamed. NSAIDS
don't relieve pressure on the median nerve, but they may make you feel better.
Corticosteroids may be a treatment option when NSAIDs don't effectively relieve pain and
inflammation. But these are powerful anti-inflammatory medicines. They have side effects
that should be considered. Corticosteroids can be taken in pill form or injected into the wrist
by a doctor.
What to think about
Medicine should be used with other measures (such as ice, rest, and splints) to reduce pain and
inflammation.
Corticosteroids:
Usually aren't used until nonsurgical treatments (such as rest, ice, splints, or anti-inflammatory
medicines) have been tried for several weeks with no improvement.
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BLOCK4-PBL5 : CARPAL TUNNEL SYNDROME

BIOLOGICAL

  1. Anatomy of hand and nerve supply (incl nerve injury of hand)
  2. Anatomy of Carpal Tunnel Syndrome
  3. Pathogenesis and pathophysiology of CTS

Median nerve microcirculation injury

Ischemic vascular injury and the breakdown in the blood-nerve barrier have also been identified as an essential component in CTS. The blood-nerve-barrier is formed by the inner cells of the perineurium and the endothelial cells of endoneurial capillaries that accompany the median nerve through the carpal tunnel. These endoneurial microvessels are formed from nutrient branches that arise from the radial and ulnar arteries, proximal to the flexor retinaculum. An increase in pressure within the tunnel can cause a breakdown of vasculature within this barrier, causing an accumulation of proteins and inflammatory cells. This may induce a miniature closed compartment syndrome by increasing the permeability, contributing to increased endoneurial fluid pressure and development of an intra-fascicular edema. Patients with vascular problems or prolonged exposure to static loading are particularly prone to a breakdown in the blood-nerve- barrier.

Pain- irritation of nerve

Tingling and numbness – CTS pt affect medial nerve sensory innervation

Vasodilation and stasis of movement during sleep so it shows symptoms during morning and sleep.

  1. Pharmacology of NSAIDs

NSAIDs work on a chemical level. They block the effects of special enzymes -- specifically Cox-1 and Cox-2 enzymes. These enzymes play a key role in making prostaglandins. Contributor to inflammatory process. By blocking the Cox enzymes, NSAIDs stop your body from making as many prostaglandins. This means less swelling and less pain.

Nonsteroidal anti-inflammatory drugs (NSAIDs) may relieve pain and inflammation and are available with or without a prescription. They work best if your tendon is inflamed. NSAIDS don't relieve pressure on the median nerve, but they may make you feel better.

Corticosteroids may be a treatment option when NSAIDs don't effectively relieve pain and inflammation. But these are powerful anti-inflammatory medicines. They have side effects that should be considered. Corticosteroids can be taken in pill form or injected into the wrist by a doctor.

What to think about

Medicine should be used with other measures (such as ice, rest, and splints) to reduce pain and inflammation.

Corticosteroids:

Usually aren't used until nonsurgical treatments (such as rest, ice, splints, or anti-inflammatory medicines) have been tried for several weeks with no improvement.

Often provide temporary relief (for several weeks or more). Injected corticosteroids usually provide longer-lasting results than those taken by mouth (oral). But oral or injected medicines rarely provide permanent relief from carpal tunnel symptoms.

CLINICAL

  1. Types and nerve injury generally
    • RADIAL NERVE INNERVATES ALL MUSCLE IN POSTERIOR FOREARM AND ARM
  2. Signs and symptoms

Carpal tunnel syndrome can cause tingling, numbness, weakness, or pain in the fingers or hand. Some people may have pain in their arm between their hand and their elbow.

Symptoms most often occur in the thumb, index finger, middle finger, and half of the ring finger. If you have problems with your other fingers but your little finger is fine, this may be a sign that you have carpal tunnel syndrome. A different nerve gives feeling to the little finger. You may first notice symptoms at night. You may be able to get relief by shaking your hand.

  1. Test and investigations for CTS – Phalen’s Test, Tinel’s Test, nerve conduction test

(i) Exam Overview : Physical exam for carpal tunnel symptoms, your doctor will:

  • Examine your neck, arms, wrists, and hands, comparing the strength and appearance of both sides.
  • Check your thumb for strength and movement by watching you grip or pinch an object.
  • Examine other parts of your arm, to check for problems with another nerve in your arm. If your doctor suspects neck-related problems, he or she will also check your neck for possible nerve compression.

(ii) Tinel's sign test

  • Your doctor taps on the inside of your wrist over the median nerve. If you feel tingling, numbness, "pins and needles," or a mild "electrical shock" sensation in your hand when tapped on the wrist, you may have carpal tunnel syndrome.

iii. Phalen's sign test

  • You hold your arms out in front of you and then flex your wrists, letting your hands hang down for about 60 seconds. If you feel tingling, numbness, or pain in the fingers within 60 seconds, you may have carpal tunnel syndrome.
  • Stop activities that cause numbness and pain. Rest your wrist longer between activities.
  • Ice your wrist for 10 to 15 minutes 1 or 2 times an hour.
  • Try taking nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and reduce swelling.
  • Wear a wrist splint at night. This takes pressure off your median nerve.
  • The sooner you start treatment, the better your chances of stopping symptoms and preventing long-term damage to the nerve.
  • You also may need medicine for carpal tunnel syndrome or for a health problem that made you likely to get carpal tunnel syndrome.
  • Surgery is an option. But it's usually used only when symptoms are so bad that you can't work or do other things even after several weeks to months of other treatment.
  1. Complications
    • PERMANENT DAMAGE TO THE MEDIAN NERVE
    • ATROPHY

BEHAVIORAL

  1. Risk factor

Things that put you at risk for carpal tunnel syndrome include:

  • Health problems or illnesses that can cause arm pain or swelling in the joints and soft tissues in the arm, or reduce the blood flow to the hands. These include obesity, rheumatoid arthritis, diabetes, lupus, hypothyroidism, and multiple sclerosis.
  • Being female. Women between the ages of 40 and 60 have the highest risk. Pregnant women near the end of their pregnancies often have short-term symptoms. Women taking birth control pills, going through menopause, or taking estrogen are also thought to be at risk.
  • Hand and wrist movements and activities that require repeated motions, especially in awkward positions.
  • Smoking. It may contribute to carpal tunnel syndrome by affecting the blood flow to the median nerve.
  • Broken wrist bones, dislocated bones, new bone growth from healing bones, or bone spurs. These can take up space in the carpal tunnel and put more pressure on the median nerve.
  • Tumours and other growths (such as ganglions). These uncommon causes of carpal tunnel syndrome are usually benign.
  • Normal wear and tear of the tissues in the hand and wrist caused by aging.

A number of factors have been associated with carpal tunnel syndrome. Although they may not directly cause carpal tunnel syndrome, they may increase your chances of developing or aggravating median nerve damage. These include:

  • Anatomic factors. A wrist fracture or dislocation, or arthritis that deforms the small bones in the wrist, can alter the space within the carpal tunnel and put pressure on the median nerve. People with smaller carpal tunnels may be more likely to have carpal tunnel syndrome.
  • Sex. Carpal tunnel syndrome is generally more common in women. This may be because the carpal tunnel area is relatively smaller in women than in men. Women who have carpal tunnel syndrome may also have smaller carpal tunnels than women who don't have the condition.
  • Nerve-damaging conditions. Some chronic illnesses, such as diabetes, increase your risk of nerve damage, including damage to your median nerve.
  • Inflammatory conditions. Illnesses that are characterized by inflammation, such as rheumatoid arthritis, can affect the lining around the tendons in your wrist and put pressure on your median nerve.
  • Obesity. Being obese is a significant risk factor for carpal tunnel syndrome.
  • Alterations in the balance of body fluids. Fluid retention may increase the pressure within your carpal tunnel, irritating the median nerve. This is common during pregnancy and menopause. Carpal tunnel syndrome associated with pregnancy generally resolves on its own after pregnancy.
  • Other medical conditions. Certain conditions, such as menopause, obesity, thyroid disorders and kidney failure, may increase your chances of carpal tunnel syndrome.
  • Workplace factors. It's possible that working with vibrating tools or on an assembly line that requires prolonged or repetitive flexing of the wrist may create harmful pressure on the median nerve or worsen existing nerve damage.

However, the scientific evidence is conflicting and these factors haven't been established as direct causes of carpal tunnel syndrome.

Several studies have evaluated whether there is an association between computer use and carpal tunnel syndrome. However, there has not been enough quality and consistent evidence to support extensive computer use as a risk factor for carpal tunnel syndrome, although it may cause a different form of hand pain.

  1. Awareness (aldryn)
  2. Prevention
  • Take good care of your general health. This includes staying at a healthy weight, not smoking , and getting regular exercise.
  • Keep your arm, hand, and finger muscles strong and flexible.
  • Stop any activity that you think may be causing finger, hand, or wrist numbness or pain.
  • Use hand and wrist movements that spread the pressure and motion evenly throughout your hand and wrist. For example, keep your wrists straight or only slightly bent. Avoid activities that bend or twist the wrists for long periods of time.
  • Switch hands and change positions often when you are doing repeated motions. Take breaks, and rest your hands.
  • Use correct posture.
  • Restrict your salt intake if you tend to retain fluid.
  • Wear a wrist splint when you cannot control your wrist motion, such as while sleeping. A splint can keep your wrist in a neutral position-that is, not bent too far forward or back-and reduce the stress on your fingers, hand, or wrist.