Carpal Tunnel Syndrome

Mr Sreeram Pennawww.eyst.org

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Carpal tunnel syndrome

• Carpal tunnel syndrome is a term used to describe a group of symptoms associated with compression of median nerve at the wrist

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Anatomy – Carpal tunnel

• Boundaries: flexor retinaculum, carpal bones• Contains: Median nerve, flexor tendons (FDS,

FDP, FPL)• Diameter: 2 cm

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Anatomy – Median nerve

• Median nerve lies beneath flexor retinaculum.• Distal end of FR Median nerve gives recurrent

motor branch and then divides in to digital branches (extraligamentous pattern). Although this can vary and less commonly it can emerge in subligamentous or transligamentous patterns.

• Palmar cutaneous branch has been reported to branch through palmaris tendon proximal to palmar fascia.

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Clinical Findings

• Simptoms: parasthesia and numbness in median nerve distribution. Aches in thenar eminence.

• Signs: of thenar muscle atrophy.• Tests: Tinel’s test, Phalen’s test• Investigations: Nerve conduction studies.

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Management

• Non Operative• Operative

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Non Operative Management

• Wrist Splinting in neutral position, especially during night time

• Steroid injection• Nerve gliding and stretching exercises

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Operative Management

• Open Technique• Endoscopic Technique: adv – small incision

dis-adv – iatrogenic nerve injury, poor visualisation, inability to identify anatomic variations, and incomplete release.

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Open Technique• Anaesthesia: simple local, regional(Biers block)

rarely general.• Tourniquet: upper arm usually, but in obese and

very thin individuals forearm tourniquet.• Incision: curvilinear incision of 2 or 3 cm made 6

mm ulnar to Thenar crease.• Dissect and identify flexor retinaculum and

completely divide it.• Closure with 4 ‘0’ nylon. Bulky dressings for 48

hours

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Post Operative management

• Bulky dressing up to 48 hours for comfort• Removal of sutures in 10 to 12 days• Wrist splint neutral position used at night for

3 weeks• 1 month post op return to work with 2 lb

limitation. 2 months back to normal work

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Thank you

For discussion about surgical training and more teaching topics visit

www.eyst.org Early Years Of Surgical Training Group

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