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Carpal Tunnel Syndrome (CTS)
Published in Charles Theisler, Adjuvant Medical Care, 2023
Carpal tunnel syndrome is the most common entrapment neuropathy. Compression of the median nerve in the carpal tunnel of the wrist causes numbness, tingling, and pain on the palm side of the thumb and most fingers, except the small finger. The pain or numbness can be especially bad at night. Women are far more likely than men to develop CTS. Conditions that can lead to developing CTS include trauma, diabetes, hypothyroidism, pregnancy, and rheumatoid arthritis. If left untreated, CTS can cause chronic pain, muscle wasting, and weakness in the affected thumb and fingers leading to impairment and disability.
Thermography by Specialty
Published in James Stewart Campbell, M. Nathaniel Mead, Human Medical Thermography, 2023
James Stewart Campbell, M. Nathaniel Mead
Carpal tunnel syndrome, a common form of peripheral nerve entrapment, is caused by compression of the median nerve as it traverses under the flexor retinaculum at the wrist, accompanied by the flexor tendons of the fingers and thumb. Irritation of the flexor tendons or their synovial sheaths can result in swelling that narrows the carpal tunnel, placing pressure on the nerve. Bony deformities at the wrist due to injury or arthritis can also compress the median nerve. The neural distribution of the median nerve includes the volar thumb, index, and middle fingers, and the radial half of the ring finger (see Figure 11.48). Classically, CTS patients experience numbness, weakness, tingling, burning, and pain affecting at least two of the digits supplied by the median nerve.89
Paper 4
Published in Aalia Khan, Ramsey Jabbour, Almas Rehman, nMRCGP Applied Knowledge Test Study Guide, 2021
Aalia Khan, Ramsey Jabbour, Almas Rehman
Carpal tunnel syndrome exhibits the following clinical features: numbness, paraesthesiae in the hand including thumb, index, middle and radial half of the ring finger. It is more common in pregnancy, obesity, diabetics, rheumatoid arthritis and hyperparathyroidism.
Successful treatment of acute worsening complex regional pain syndrome in affected dominant right-hand from secondary pathology of new onset third and fourth digit trigger finger
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
After three years of having CRPS symptoms, he developed acute worsening of right-hand pain and was unable to extend the right third and fourth digit. Physical exam revealed the onset of trigger finger of the right third and fourth digit with painful finger extension and loss of finger range of motion. Typically, trigger finger also called stenosing tenosynovitis is caused by hypertrophy of the finger flexor tendon sheath A1 pulley resulting in digit locking in a flexed position [7]. Pain was excruciating and severely worse than the previous baseline CRPS symptoms. The pain was constant in nature, impairing sleep, and causing the patient to become severely depressed with suicidal ideation. Additionally, activities of daily living were becoming increasingly difficult due to the loss of right-hand function.
Functional reconstruction of a hand that was severely deformed due to Jaccoud’s arthropathy
Published in Modern Rheumatology Case Reports, 2021
Kei Funamura, Hajime Ishikawa, Rika Kakutani, Asami Abe, Hiroshi Otani, Kiyoshi Nakazono, Akira Murasawa
Santiago reported that Jaccoud’s arthropathy was categorised to the other non-inflammatory musculoskeletal conditions and was generally observed in not only the hand but also the foot [5], knee [6], and shoulder [7]. The most common joint deformity was ulnar deviation, swan-neck deformity and boutonniere deformity of the fingers, Z deformity of the thumb, and hallux valgus deformity [8]. Jaccoud’s arthropathy is characterised by "reversible" joint deformity, unlike rheumatoid arthritis (RA), which causes irreversible deformity with joint destruction. The deformity is caused by a loss of mechanical balance following not synovitis in the joint but weakening, elongation, and disappearance of the supporting soft tissue structures, such as the ligaments, tendons, and joint capsules [8].
Two patients with mixed connective tissue disease complicated by pulmonary arterial hypertension showing contrasting responses to pulmonary vasodilators
Published in Modern Rheumatology Case Reports, 2020
Katsuhide Kusaka, Kazuhisa Nakano, Shigeru Iwata, Satoshi Kubo, Tomoya Nishida, Yoshiya Tanaka
Mixed connective tissue disease (MCTD) was proposed by Sharp et al. [1] in 1972. It clinically involves at least 2 of the following 3 manifestations: systemic lupus erythematosus (SLE)-like manifestation, systemic sclerosis (SSc)-like manifestation, and polymyositis/dermatomyositis (PM/DM)-like manifestation. Serologically, it is characterised by positivity for only high-titer anti-U1-ribonucleoprotein (U1-RNP) antibody. This disease is associated with a wide range of organ dysfunctions. Raynaud’s phenomenon and finger swelling are physical findings that aid in its diagnosis. In this disease, pulmonary arterial hypertension (PAH) is the most important organ dysfunction that defines prognosis. PAH is a prognostic factor for not only MCTD but also SLE and SSc. On comparing PAH with idiopathic pulmonary arterial hypertension (IPAH) without any underlying diseases, such as connective tissue diseases (CTDs), PAH might be more responsive to immunosuppressive therapy as well as pulmonary vasodilators. PAH is one of the disease types of broadly defined pulmonary hypertension (PH), and its recommended therapies differ from those for other types of PH. CTDs, such as MCTD, are complicated by multiple organ dysfunctions because of their various clinical pathological conditions. Thus, it is necessary to appropriately diagnose the disease type of PH, classify the severity, and select treatment accordingly. Here, we present 2 cases of MCTD complicated by PH that had contrasting clinical courses.