Carpal Tunnel Syndrome

by Kevin Pei, MD

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    00:01 Welcome back.

    00:02 Thanks for joining me on this discussion of carpal tunnel syndrome in the section of vascular surgery.

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

    00:13 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.

    00:24 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.

    00:35 And there's a slight preponderance of female patients, short patients, previous wrist fractures and as an occupational hazard.

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

    00:57 Sometimes patients report heaviness in the hand, like it’s falling asleep.

    01:02 And patient may have decreased grip strength or at least decreased when compared to the contralateral side.

    01:12 Symptom relief when shaking hands can be bilateral.

    01:17 Let's now discuss the nerve distribution and symptom distribution with patients in carpal tunnel syndrome.

    01:23 When patients complain of pain, it’s usually on the ventral aspect of the hand.

    01:27 That's the palmar side.

    01:30 In terms of sensory deficits, it usually involves the palmar aspect of digits one, two and three and the radial half of the fourth digit.

    01:38 Remember, through the carpal tunnel actually runs two nerves: the radial nerve and the median nerve.

    01:44 Compression symptoms usually involve only the median nerve.

    01:48 And lastly, motor atrophy or weakness in the median nerve distribution, specifically in the thenar muscles or the fatty pad or the muscular pad just underneath your thumb.

    02:00 Let's discuss some classic signs of carpal tunnel syndrome.

    02:04 First, the Tinel sign.

    02:06 The Tinel sign is to illicit a tingling in the distribution of the median nerve by tapping over the median nerve.

    02:13 Next, the Phalen sign.

    02:15 The Phalen sign is described as tingling in the median nerve distribution with hyperflexion of the wrists.

    02:21 And lastly, compression test.

    02:23 The compression test tries to mimic the carpal tunnel syndrome by full compression of the carpal tunnel.

    02:29 This may demonstrate the same neurological findings.

    02:36 Laboratories are not going to be helpful.

    02:38 So, don't get routine labs on these patients.

    02:41 And similarly, imaging studies are generally not helpful either.

    02:45 This disease process is largely dependent on a physical examination and a good history.

    About the Lecture

    The lecture Carpal Tunnel Syndrome by Kevin Pei, MD is from the course Special Surgery.

    Included Quiz Questions

    1. Tinel sign
    2. Phalen sign
    3. Trousseau's sign
    4. Chvostek sign
    5. Valleix sign
    1. Tissue swelling.
    2. Heaviness in hand.
    3. Decreased grip strength.
    4. Numbness.
    5. Atrophy.

    Author of lecture Carpal Tunnel Syndrome

     Kevin Pei, MD

    Kevin Pei, MD

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