Friday, July 25, 2003
Management of Carpal Tunnel Syndrome - July 15, 2003 - American Family Physician
Summary
- hypalgesia and weak thumb abduction predict abnormal nerve conduction
studies. - splint the wrist in a neutral position and ultrasound therapy.
- local corticosteroid injections can help
- nonsteroidal anti-inflammatory drugs, pyridoxine, and diuretics don't
work - treat conservatively (splint) in pregnant women, resolves after delivery
- Nonspecific flexor tenosynovitis is the most common cause
History
- flick sign: "flick" wrist as if shaking down a thermometer for relief
Nerve Conduction Studies
NCS findings have only a loose association with symptoms. In one popn study
(below) having symptoms tripled the probability of a positive study, but the
half of studies in symptomatic patients are negative. Would be very good to know
what happened over time to the asymptomatic group with a positive NCS.
- 15%: pain, numbness, or tingling median nerve distn.
- half had neuropathy by NCS
- clinical certainty did not predict NCS findings
- a subgroup of pts. with no symptoms hand NCS done:
- 18% had median nerve neuropathy by NCS
Treatment
- this paper includes an instrument for predicting the outcome of
conservative treatment. If probability of success is low, consider early
surgery?
- risk factors for failure: > 10 months, constant parathesias, trigger
digits, age > 50, phalen +ve<30 sec
- risk factors for failure: > 10 months, constant parathesias, trigger
- outcomes
- Only 1/6 pts have long term relief with conservative mgt (80% initial
response, but only 1/5 of those do not recur by 1 year) - 2/3 patients very satisfied 6/18/30 mo post surgery
- Only 1/6 pts have long term relief with conservative mgt (80% initial
- injection: 10 of lidocaine (Xylocaine) without epinephrine and 40 mg of
methylprednisolone acetate (Depo-Medrol)
