Medical history (history of illness) represents an important component in the diagnosis of carpal tunnel syndrome. Family history Do any other people in your family suffer from these symptoms? Social history What is your profession? Current medical history/systemic history (somatic and psychological complaints). What changes have you noticed? How long have these changes existed? Do … Carpal Tunnel Syndrome: Medical History
Cardiovascular System (I00-I99). Raynaud’s syndrome (Raynaud’s disease) – vascular disease characterized by seizure-like paling of the hands or feet due to vasospasm. Infectious and parasitic diseases (A00-B99). Lyme disease – infectious disease transmitted by ticks. Psyche – nervous system (F00-F99; G00-G99) Polyneuropathy – pathological change of several nerves, leading mainly to paresthesias (insensations). Polymyalgia rheumatica … Carpal Tunnel Syndrome: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by carpal tunnel syndrome: Psyche – Nervous System (F00-F99; G00-G99). Paresis (paralysis)/paresthesias (sensory disturbances) of the hand. Musculoskeletal system and connective tissue (M00-M99). Tenovaginitis stenosans (fasting finger or snapping finger) – in tendovaginitis stenosans de Quervain, the tightness is localized to … Carpal Tunnel Syndrome: Complications
The following symptoms and complaints may collectively indicate carpal tunnel syndrome: Leading symptom Hand falling asleep, especially at night, often associated with pain (brachialgia paraesthetica nocturna) [50-60% of cases involve both hands; risk of confusion with cervical spine syndrome, polyneuropathy, or cervical myelopathy-see under differential diagnoses]. Associated symptoms Painful paresthesias (paraesthetics) such as tingling, pins … Carpal Tunnel Syndrome: Symptoms, Complaints, Signs
Pathogenesis (development of disease) The etiopathogenesis of carpal tunnel syndrome (KTS) is multifactorial and most cases are classified as idiopathic; 50-60% of cases are bilateral (bilateral). KTS requires as a prerequisite an anatomical narrowing in the region of the carpus. The symptoms described above are caused by an increase in volume of the tunnel contents. … Carpal Tunnel Syndrome: Causes
General measures Avoiding overexertion, e.g., heavy mechanical work. Use of ergonomic keyboards Medical aids In the early stages of the disease: wearing a palmar (palm-side) wrist splint in the neutral position (night splint) at night; see also under Carpal tunnel syndrome/medical therapy: comparison of methods “wrist splint versus single corticosteroid injection” Nutritional Medicine Nutritional counseling … Carpal Tunnel Syndrome: Therapy
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin and mucous membranes Hand [atrophy (tissue atrophy) of the thenar musculature/thumb pad muscles and sensory disturbances (of the palm and fingers 1-3 including the radial side of the … Carpal Tunnel Syndrome: Examination
Therapy target Improvement of symptomatology Therapy recommendations Anti-inflammatory drugs (non-steroidal anti-inflammatory drugs, NSAIDs), e.g., diclofenac, ibuprofen [no sustained significant effect!]. In the early stages of the disease: night splinting of the wrist and local infiltration of cortisone (glucocorticoids); as short and low doses as possible (e.g. once 20 mg methylprednisolone) Cave (Warning)! With infiltration (“insertion”; … Carpal Tunnel Syndrome: Drug Therapy
Optional medical device diagnostics – depending on the results of the history, physical examination, and obligatory laboratory parameters – for differential diagnostic clarification. Sensory/motor electro-neurography (ENG) – to determine nerve conduction velocity: Sensory nerve conduction velocity (NLG) of median nerve: > 8 m/s lower than compared to ulnar nerve [method with the highest sensitivity (percentage … Carpal Tunnel Syndrome: Diagnostic Tests
Surgical therapy for carpal tunnel syndrome is superior to conservative therapy. Decompression of KTS is one of the most common operations worldwide. Indications (areas of application) Persistent sensory disturbances Therapy-resistant nocturnal pain (brachialgia paraesthetica nocturna) or paresthesias with sleep disturbances. Surgical procedure Open splitting of the retinaculum/retaining ligament (with or without neurolysis/surgery to remove the … Carpal Tunnel Syndrome: Surgical Therapy
To prevent carpal tunnel syndrome, attention must be paid to reducing individual risk factors. Behavioral risk factors Caused by overuse, such as heavy mechanical work (occupational disease* ): Exposure to hand-arm vibrations (vibrations). Increased effort of the hands (powerful gripping). Repetitive manual activities with flexion (bending) and extension (stretching) of the hands in the wrist. … Carpal Tunnel Syndrome: Prevention
