- 354.0 Carpal tunnel syndrome
- G56.01 Carpal tunnel syndrome, right upper limb
- G56.02 Carpal tunnel syndrome, left upper limb
- Pain, paresthesias, and sensory loss perceived on radial
side of the palm and the palmar side of thumb, index, middle, and
radial side of the ring fingers
- Pain may radiate up to the elbow, shoulder, neck
- Waking from pain at night is hallmark of this condition2
- In advanced cases, motor dysfunction in thenar muscles may
occur, characterized by weakness, atrophy, loss of coordination
- In entrapment neuropathy, nerve becomes compressed, causing
ischemic damage to the nerve
- The carpal tunnel is a constrained area at the
wrist bounded by the carpal bones and the transverse carpal ligament (flexor retinaculum)
- The median nerve and 9 flexor tendons pass through
the carpal tunnel
- Pathomechanics involve decreased size of the tunnel or increased
volume of the contents, causing compression on median nerve
- Often associated with repetitive motions or sustained position
of the wrist and hand
- Unrelieved compression of the nerve results in neurapraxia
with segmental demyelination further ischemic damage
results in axonotmesis and wallerian degeneration
- Incidence: 3.5 cases per 1,000 in general population
- Prevalence: 2.1%
- Most common entrapment neuropathy
- More common in women than men (70% of cases are female)
- 2.5 times more common in obese individuals
- Most common among people aged 30 to 60 years
- Nearly one-half of cases will experience bilateral symptoms
- First symptom is usually pain or paresthesias;
most commonly with gradual onset
- Pain complaints include numbness (most common), tingling,
- Pain or numbness waking the patient at night is very common
- Pain is experienced in distribution of the median nerve in
the hand, though may radiate up to elbow, shoulder, or neck
- Tenderness to percussion or pressure over the carpal tunnel
- Pain may be worse with extreme wrist flexion or extension
- Sensory loss may follow early symptom of pain
- Motor involvement (weakness, loss of coordination, atrophy)
may follow in more advanced cases
- Pain with wrist movements
- Difficulty with grasping and manipulation activities
- Dropping items from the hand
- Impaired sensation
- Loss of strength in advanced cases
- Most often idiopathic
- Genetic structural factors
- Swelling of synovial tissues ...
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