Carpal Tunnel Syndrome

00:01 Welcome back.

00:02 Thanks for joining me on this discussion of Carpal Tunnel Syndrome in this section of vascular surgery.

00:08 Let's begin by discussing the potential etiologies of carpal tunnel.

00:12 It's associated with the compression of the median nerve from various reasons.

00:18 We generally think of it as a multifactorial disease, and heavily associated with overuse.

00:23 For example, a patient may be typing on the keyboard all day long.

00:28 There's also an association with Body Mass Index with obesity associated with it.

00:34 And there's a slight preponderance of female patients.

00:38 Short patient's, previous risk fractures, and as an occupational hazard.

00:47 On physical examination, and historically, the patient would complain of numbness in the hands marginally, in the distribution of the median nerve.

00:57 Sometimes patient report heaviness in the hand, like it falling asleep.

01:02 And patient may have decreased grip strength, or at least decrease when compared to the contralateral side and thernar muscle wasting.

01:12 Let's now discuss the nerve distribution, and symptom distribution with patients in carpal tunnel syndrome.

01:18 When patients complain of pain, it's usually on the volar aspect of the hand.

01:21 it's usually on the volar aspect of the hand.

01:23 That's the palmar side.

01:25 In terms of sensory deficits, it usually involves a palmar aspect of digits one, two, and three and the radial half of the fourth digit.

01:33 and the radial half of the fourth digit.

01:33 And lastly, motor atrophy or weakness in the median nerve distribution, specifically in the thinner muscles, or the fatty pad, or the muscular pad just underneath your thumb.

01:45 Many patients initially present with the electric shock like sensations that awaken them from sleep.

01:52 Let's discuss some classic signs of carpal tunnel syndrome.

01:56 First, the Tinel sign.

01:57 The Tinel sign is elicited tingling in the distribution of the media nerve by tapping over the media nerve.

02:04 Next, the Phalen sign.

02:07 The Phalen sign is described as tingling in the median nerve distribution with hyperflexion of the wrist.

02:13 And lastly, Compression test.

02:15 The compression test tries to mimic the carpal tunnel syndrome by full compression of the carpal tunnel.

02:21 This may demonstrate the same neurological findings.

02:27 Laboratories are not going to be helpful.

02:30 So don't get routine labs on these patients.

02:33 And similarly, imaging studies are generally not helpful either.

02:37 This disease process is largely dependent on a physical examination and a good history.

02:44 Nerve conduction velocities in Electromyography or EMGs are very helpful both to confirm the diagnosis and to detect permanent nerve damage from chronic compression.

02:54 Many insurance companies even require this confirmation step prior to approving any operative procedures.