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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
Other Complications of Diabetes
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Signs and symptoms of carpal tunnel syndrome include hand and wrist pain, tingling, numbness, along the path of the median nerve. Sometimes, the entire hand is affected. The patient often wakes up at night with aching or burning pain, numbness, and tingling. Shaking the hand back and forth can relieve the pain and restore normal sensation. Later in the disease course, there may be thenar atrophy, and weakness of thumb opposition and abduction. Dupuytren contracture begins with tender palm nodules usually near the pinky or ring finger that gradually become painless. A superficial cord then forms, contracting the metacarpophalangeal joints and interphalangeal joints, resulting in arching of the hand. There may be fibrous thickening of the dorsum of the proximal interphalangeal joints. With diabetes, there can also be locked trigger fingers, systemic sclerosis, chronic reflex sympathetic dystrophy, and an ulnar claw hand.
Paper 1
Published in Aalia Khan, Ramsey Jabbour, Almas Rehman, nMRCGP Applied Knowledge Test Study Guide, 2021
Aalia Khan, Ramsey Jabbour, Almas Rehman
Carpal tunnel syndrome is diagnosed clinically by: Symptoms reproduced when the wrist is forcibly palmar flexed and pressure applied to the median nerveSymptoms reproduced by tapping directly on the ulnar nerveSymptoms reproduced by forcibly extending the wrist and applying pressure to the median nerveExtending both wrists for 30 seconds to reproduce symptomsDetecting the presence of hypothenar muscle wasting.
Cross-sectional changes of the distal carpal tunnel with simulated carpal bone rotation
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Carpal tunnel syndrome is a peripheral nerve entrapment syndrome affecting a large portion of the general (Atroshi et al. 1999) and working populations (Dale et al. 2013; Luckhaupt et al. 2013). The most common treatment for carpal tunnel syndrome is to undergo carpal tunnel release surgery, whereby pressure at the median nerve is relieved by transecting the transverse carpal ligament (TCL) (Badger et al. 2008; Rodner and Katarincic 2008). Regarding various patient outcome measurables, surgical treatment shows preferred results, as compared to those for therapeutic options such as splinting (Gerritsen et al. 2002), non-steroidal anti-inflammatory drugs (Jarvik et al. 2009) and steroid injections (Hui et al. 2005). Although surgery is more effective, the invasive nature of the procedure does present the risk of complications, albeit rare (Karl et al. 2016). Such risks are minimal with noninvasive physical therapeutics. These options, which can include splinting (Huisstede et al. 2010) and carpal bone mobilization (Huisstede et al. 2010), often involve force application at or near the radiocarpal or midcarpal joint. These force applications are likely to induce relative motion of the carpal bones.
Multicenter pragmatic study of carpal tunnel release with ultrasound guidance
Published in Expert Review of Medical Devices, 2022
John R. Fowler, Kevin C. Chung, Larry E. Miller
The eligibility criteria for this observational study were purposely broad to reflect a heterogenous sample of CTS patients treated in routine clinical practice. Patient diagnosis was determined according to the practice patterns of each participating physician, all of whom were experienced in the diagnosis and management of CTS. Carpal tunnel syndrome was diagnosed primarily on clinical grounds, with ancillary testing such as electrophysiological studies ordered at the discretion of the physician. Eligible patients were adults (age ≥18 years) who were treated with CTR-US and demonstrated a willingness to participate in the registry and participate in specified follow-up activities. The decision to receive CTR-US was determined on a case-by-case basis considering physician and patient preferences. No limitations were imposed on maximum patient age, medical or surgical history, or clinical presentation.
Ischemia of the fingers after carpal tunnel syndrome treatment
Published in Case Reports in Plastic Surgery and Hand Surgery, 2020
Niels H. Bosma, Tjeerd R. de Jong
After two weeks the patient complained mainly of an intense cold-intolerance of the affected fingers. The marbled aspect of the fingers was unchanged. However, closer inspection of the nails showed massive splinter hemorrhages in the ulnar three digits (Figure 2). An angiography was performed to rule out an active cause of micro-embolism. This showed a curved aspect of the ulnar artery at the level of the distal radio-ulnar joint (DRUJ) (Figure 3(A)). No aneurysmatic changes or vascular wall irregularities were identified, but decreased contrast filling of the digital arteries of the ulnar three fingers was obvious (Figure 3(B)). Some sudden stops distally in the digital arteries confirmed the assumption of microembolic occlusion by steroid particles. A carpal tunnel release was performed several months after the event. With cold intolerance as the only lasting complaint, the patient was discharged from further follow-up.