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1、CarpalTunnelSyndromeHand/Finger/WristIssuesPresentation:A64-year-old,right-handed,retiredwomanpresentswith:intermittentnumbness,tingling,andburningpainLocation:ThethreeradialdigitsofbothhandsDuration:HadthesesymptomsforthreemonthsHistory:Thesesymptom
2、sawakenherseveraltimeseachnight.Onexamination:Shehasnoatrophyofthethenarmuscles.Sensationtolighttouchisintact.Howshouldshebeevaluatedandtreated?2Scopeoftheproblem2.7millionofficevisitsDifferentialdiagnosis:Entrapmentsofthenerves-Carpaltunnelsyndrome,
3、EntrapmentoftheulnarnerveCervicalradiculopathyTendondisorders,Overuseofmuscles,Nonspecificpainsyndromes3CTAnatomy4CTSDataF:3%,M:2%,Averageage:55yrsElevatedpressureinthecarpaltunnelResultsinischemiaofthemediannerveCausesimpairednerveconductionandatten
4、dantparesthesiaandpainRelatedConditions:PregnancyInflammatoryarthritis-RAColles’fractureAmyloidosisHypothyroidismDiabetesmellitus6%AcromegalyUseofcorticosteroidsandestrogens5CTS:OccupationalRepetitiveactivitiesofthehandandwristparticularlywithacombin
5、ationofforcefulandrepetitiveactivities:FoodprocessingManufacturingLoggingConstructionworkDataentry6HistoryPain,tingling,burning,numbness,orsomecombinationofthesesymptomsonthepalmaraspectofthethumb,indexfinger,middlefinger,andradialhalfoftheringfinger
6、NosuchsymptomsaffectthefifthfingerNocturnalsymptomsreported(51-77%)“FlickSign”:Shakethesymptomatichandorhandswhensymptomsareattheirworstgivesrelief7AssessmentLatesigns:Lossoftwo-pointdiscriminationinthemediannervedistributionThenaratrophyPhalen’smane
7、uver:Flexionofthewristfor60secondselicitspainorparesthesiainthemedian-nervedistribution(40-80%)Tinel’ssign:Presentiftappinglightlyoverthevolarsurfaceofthewristcausesradiatingparesthesiainthedigitsinnervatedbythemediannerve(67-87%)8TherapiesTreatassoc
8、iatedconditionsWristsplintalleviatessymptoms(80%);maintainthewristinneutralpostureratherthaninextensionMedications-?NSAIDs,B6Prednisonehelps(10mg/day)LocalCorticosteroidInjection(75%relief)symptomsrecurwithin1yr(Poorprognosis:constantnumbness,impaire
