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Welcome back.
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Thanks for joining me
on this discussion
of Carpal Tunnel Syndrome
in this section of vascular surgery.
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Let's begin by discussing
the potential etiologies
of carpal tunnel.
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It's associated with the compression
of the median nerve
from various reasons.
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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.
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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.
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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.
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That's the palmar side.
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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.
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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.
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Next, the Phalen sign.
02:07
The Phalen sign is
described as tingling
in the median
nerve distribution
with hyperflexion of the wrist.
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And lastly,
Compression test.
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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.
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So don't get routine labs
on these patients.
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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.