Objective 3: Recognize common injuries to the lower extremity…
Common Extremity Injuries
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Transcript of Common Extremity Injuries
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Acromioclavicluar SeparationAcromioclavicluar Separation
Acromioclavicular (AC) joint is a diarthrodialarticulation with interposed fibrocartilaginousmeniscal disk that links the hyaline cartilage
articular surfaces of the acromial process and theclavicle
Joint is stabilized by a combination of dynamicmuscular and static ligamentous structures, whichallow a normal anatomic range of motion Because of the transverse orientation of the articulation,
direct downward forces may result in shear stressesthat cause disruption of stabilizing structures and createdisplacement beyond normal limits
Acromioclavicular (AC) joint is a diarthrodialarticulation with interposed fibrocartilaginousmeniscal disk that links the hyaline cartilage
articular surfaces of the acromial process and theclavicle
Joint is stabilized by a combination of dynamicmuscular and static ligamentous structures, whichallow a normal anatomic range of motion Because of the transverse orientation of the articulation,
direct downward forces may result in shear stressesthat cause disruption of stabilizing structures and createdisplacement beyond normal limits
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Acromioclavicluar SeparationAcromioclavicluar Separation
Severity of an AC separation is dependent
upon the degree of ligamentous injury
Capsular AC ligaments and extracapsularcoracoclavicular (CC) ligament are the
primary static stabilizers of the AC joint
Anterior and posterior AC ligaments are
predominantly responsible for maintainingstability in AP plane
Severity of an AC separation is dependent
upon the degree of ligamentous injury
Capsular AC ligaments and extracapsularcoracoclavicular (CC) ligament are the
primary static stabilizers of the AC joint
Anterior and posterior AC ligaments are
predominantly responsible for maintainingstability in AP plane
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Acromioclavicluar SeparationAcromioclavicluar Separation
Two components of CC ligament, trapezoid and
conoid ligaments, provide restraint against
compression and superior-inferior translation,
respectively Deltoid and trapezius muscles are especially
important in providing dynamic stabilization
when these ligamentous structures are
damaged
Two components of CC ligament, trapezoid and
conoid ligaments, provide restraint against
compression and superior-inferior translation,
respectively Deltoid and trapezius muscles are especially
important in providing dynamic stabilization
when these ligamentous structures are
damaged
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AnatomyAnatomy
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AnatomyAnatomy
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EpidemiologyEpidemiology
AC joint injuries are seen especially in
competitive athletes, such as rugby or
hockey players, and occur most frequently
in the second decade of life1
Males are more commonly affected than
females, with a male-to-female ratio of
approximately 5:11
AC joint injuries are seen especially in
competitive athletes, such as rugby or
hockey players, and occur most frequently
in the second decade of life1
Males are more commonly affected than
females, with a male-to-female ratio of
approximately 5:11
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Etiology/MOIEtiology/MOI
M/C MOI is a direct force applied to the
superior aspect of the acromion, usually
from a fall with the arm in an adducted
position
This impact drives the acromion inferiorly,
spraining the intra-articular AC ligaments
If the force is great enough, the extra-articularCC ligament may also be damaged
M/C MOI is a direct force applied to the
superior aspect of the acromion, usually
from a fall with the arm in an adducted
position
This impact drives the acromion inferiorly,
spraining the intra-articular AC ligaments
If the force is great enough, the extra-articularCC ligament may also be damaged
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Etiology/MOIEtiology/MOI
Less commonly, an indirect force may be
transmitted up the arm as a result of a fall
on an outstretched hand
Force continues through the humeral head to
acromial process, displacing it superiorly and
stressing AC ligaments
Coracoacromial (CA) ligaments are not injuredwith this type of mechanism
Less commonly, an indirect force may be
transmitted up the arm as a result of a fall
on an outstretched hand
Force continues through the humeral head to
acromial process, displacing it superiorly and
stressing AC ligaments
Coracoacromial (CA) ligaments are not injuredwith this type of mechanism
AC Separation
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Etiology/MOIEtiology/MOI
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ClassificationClassification
Type I injuries involve sprained, but intact
CC and AC ligaments
Type II injuries involve a complete disruptionof AC ligaments with a sprained, but intact
CC ligament
In the more severe type III injury, both the
CC and AC structures are disrupted
Type I injuries involve sprained, but intact
CC and AC ligaments
Type II injuries involve a complete disruptionof AC ligaments with a sprained, but intact
CC ligament
In the more severe type III injury, both the
CC and AC structures are disrupted
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ClassificationClassification
Type IV injuries are defined by posteriordisplacement of the clavicle relative toacromion with buttonholing through
trapezius muscle In type V injuries, clavicle is widely
displaced superiorly relative to acromion asa result of disruption of muscle attachments
Rare type VI injuries are characterized byinferior displacement of the distal claviclebelow acromial process or coracoid process
Type IV injuries are defined by posteriordisplacement of the clavicle relative toacromion with buttonholing through
trapezius muscle In type V injuries, clavicle is widely
displaced superiorly relative to acromion asa result of disruption of muscle attachments
Rare type VI injuries are characterized byinferior displacement of the distal claviclebelow acromial process or coracoid process
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ClassificationClassification
Trapezius
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Clinical PresentationClinical Presentation
Patients typically present with pain and restricted
shoulder motion after a fall
Visual inspection of patient may also provide a
significant key to diagnosis Prominent clavicle with loss of normal contour of
shoulder caused by sagging of acromion is highly
suggestive of a ligamentous disruption of the AC joint
Findings may be clearer when patient is asked to hold a10-15 pound weight in hand of affected arm
Patients typically present with pain and restricted
shoulder motion after a fall
Visual inspection of patient may also provide a
significant key to diagnosis Prominent clavicle with loss of normal contour of
shoulder caused by sagging of acromion is highly
suggestive of a ligamentous disruption of the AC joint
Findings may be clearer when patient is asked to hold a10-15 pound weight in hand of affected arm
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Functional TestingFunctional Testing
Evaluate neurovascular status and r/o
possible clavicular fracture
Pain during passive abduction from 90 to180
Pain on passive horizontal adduction
Resisted tests negative in chronic AC
problem
Positive OBriens test
Evaluate neurovascular status and r/o
possible clavicular fracture
Pain during passive abduction from 90 to180
Pain on passive horizontal adduction
Resisted tests negative in chronic AC
problem
Positive OBriens test
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OBriens TestOBriens Test
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ImagingImaging
Type V separation,characterized bywide displacement ofthe clavicle in asuperior direction
relative to theacromion
Findings denotedisruption of the AC
ligaments andcoracoclavicular (CC)ligament, as well asdeltoid attachment todistal clavicle
Type V separation,characterized bywide displacement ofthe clavicle in asuperior direction
relative to theacromion
Findings denotedisruption of the AC
ligaments andcoracoclavicular (CC)ligament, as well asdeltoid attachment todistal clavicle
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Management1Management1
Type I and Type II injuries are treated
conservatively, whereas most type III
respond to conservative care unless
significantly symptomatic several months
after injury
Challenge is to be sure that diagnosed type II is
not an misdiagnosed type IV to VI, whichrequire surgery
Type I and Type II injuries are treated
conservatively, whereas most type III
respond to conservative care unless
significantly symptomatic several months
after injury
Challenge is to be sure that diagnosed type II is
not an misdiagnosed type IV to VI, whichrequire surgery
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Management1Management1
Type I
Rest, ice, and immobilization if it relieves pain
Light friction massage over AC ligament
Symptoms resolve within 7-10 days
ROM to pain-free range
Strengthen shoulder, especially trapezius and
deltoid muscles Use sling until pain subsides
Type I
Rest, ice, and immobilization if it relieves pain
Light friction massage over AC ligament
Symptoms resolve within 7-10 days
ROM to pain-free range
Strengthen shoulder, especially trapezius and
deltoid muscles Use sling until pain subsides
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Management1Management1
Type II
Treated symptomatically, but taping, bracing, or
a Kenny-Howard sling for 1-2 weeks for up to 8
weeks
ROM to pain-free range
Strengthen shoulder, especially trapezius and
deltoid muscles
Type II
Treated symptomatically, but taping, bracing, or
a Kenny-Howard sling for 1-2 weeks for up to 8
weeks
ROM to pain-free range
Strengthen shoulder, especially trapezius and
deltoid muscles
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Management1Management1
Type III
Definite support, such as Kenny-Howard sling
Perform early ROM tests as pain
Vigorous strengthening program
Type III
Definite support, such as Kenny-Howard sling
Perform early ROM tests as pain
Vigorous strengthening program
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Kenny-Howard Sling (AC Sling)Kenny-Howard Sling (AC Sling)
http://www.tartanortho.com/AC62A2.html.pdf http://www.tartanortho.com/AC62A2.html.pdf
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Lateral EpicondylopathyLateral Epicondylopathy
Definition
Proposed that only in very early stages of
epicondylopathies is inflammation present
These tendon overuse problems are
degenerative b/c no inflammatory cells are
found
Proper term should be tendonosis
Definition
Proposed that only in very early stages of
epicondylopathies is inflammation present
These tendon overuse problems are
degenerative b/c no inflammatory cells are
found
Proper term should be tendonosis
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Lateral EpicondylopathyLateral Epicondylopathy
Epidemiology
Primarily b/w ages 35 and 50 years with median
age of 41 years, with a high activity level (sports
or occupational) three or more times per weekwith a 30-minute or greater session1
Epidemiology
Primarily b/w ages 35 and 50 years with median
age of 41 years, with a high activity level (sports
or occupational) three or more times per weekwith a 30-minute or greater session1
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Lateral EpicondylopathyLateral Epicondylopathy
Pathophysiology Many proposed etiologies for this condition have
involved inflammatory processes of the radial humeralbursa, synovium, periosteum, and the annular ligament
Mechanical stress on tendons attaching to condylesrelease substance P and peptides, indicating aneurogenic inflammatory origin1
Another proposed cause is microscopic tearing withformation of reparative tissue (ie, angiofibroblastichyperplasia) in the origin of the extensor carpi radialisbrevis (ECRB) muscle
Microtearing and repair response can lead to macroscopictearing and structural failure of the origin of the ECRB muscle
Pathophysiology Many proposed etiologies for this condition have
involved inflammatory processes of the radial humeralbursa, synovium, periosteum, and the annular ligament
Mechanical stress on tendons attaching to condylesrelease substance P and peptides, indicating aneurogenic inflammatory origin1
Another proposed cause is microscopic tearing withformation of reparative tissue (ie, angiofibroblastichyperplasia) in the origin of the extensor carpi radialisbrevis (ECRB) muscle
Microtearing and repair response can lead to macroscopictearing and structural failure of the origin of the ECRB muscle
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Lateral EpicondylopathyLateral Epicondylopathy
Anatomy
Most commonly involved tissue is the origin of
ECRB (100%), anterior edge extensor digitorum
communis (50% of time), and sometimesunderside of extensor carpi radialis longus
(ECRL)
Anatomy
Most commonly involved tissue is the origin of
ECRB (100%), anterior edge extensor digitorum
communis (50% of time), and sometimesunderside of extensor carpi radialis longus
(ECRL)
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Lateral EpicondylopathyLateral Epicondylopathy
Etiology
Any activity involving wrist extension, radial
deviation and/or supination can be associated
with overuse of the muscles originating at thelateral epicondyle
Tennis has been the activity most commonly
associated with the disorder, but might also
include plumbers and meat-cutters
Etiology
Any activity involving wrist extension, radial
deviation and/or supination can be associated
with overuse of the muscles originating at thelateral epicondyle
Tennis has been the activity most commonly
associated with the disorder, but might also
include plumbers and meat-cutters
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Lateral EpicondylopathyLateral Epicondylopathy
Clinical Presentation
Patients present complaining of lateral elbowand forearm pain exacerbated by use
Most tender area is usually on anterior/inferiorportion of lateral epicondyle or slightly distal
Often tenderness on palpation in several areasincluding ECRB, ECRB or extensor digitorum
Onset can be either acute or insidious Tenderness tends to improve with rest and
worsen with movements, especially wristextension
Clinical Presentation
Patients present complaining of lateral elbowand forearm pain exacerbated by use
Most tender area is usually on anterior/inferiorportion of lateral epicondyle or slightly distal
Often tenderness on palpation in several areasincluding ECRB, ECRB or extensor digitorum
Onset can be either acute or insidious Tenderness tends to improve with rest and
worsen with movements, especially wristextension
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Lateral EpicondylopathyLateral Epicondylopathy
Diagnosis
Definite painful resisted wrist extension with elbow
extended
Pressure can be added with extended forearm pronated May be pain and limited wrist flexion when stretching a
full flexed wrist with an extended elbow and pronated
forearm
May be loss of passive wrist flexion associated with chronic
condition due to fibrosis
May be pain on resisted finger extension, which usually
creates pain in the forearm mid-extensor area
Diagnosis
Definite painful resisted wrist extension with elbow
extended
Pressure can be added with extended forearm pronated May be pain and limited wrist flexion when stretching a
full flexed wrist with an extended elbow and pronated
forearm
May be loss of passive wrist flexion associated with chronic
condition due to fibrosis
May be pain on resisted finger extension, which usually
creates pain in the forearm mid-extensor area
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Lateral EpicondylopathyLateral Epicondylopathy
Imaging
Radiographs can be helpful in ruling out other disorders
or concomitant intra-articular pathology (i.e.,
osteochondral loose-body, posterior osteophytes) Calcification in the degenerative tissue of the ECRB muscleorigin can be seen in chronic cases
Magnetic resonance imaging can help confirm the
presence of degenerative tissue in the ECRB muscle
origin and can help diagnose concomitant pathology;however, it is very rarely needed
Imaging
Radiographs can be helpful in ruling out other disorders
or concomitant intra-articular pathology (i.e.,
osteochondral loose-body, posterior osteophytes) Calcification in the degenerative tissue of the ECRB muscleorigin can be seen in chronic cases
Magnetic resonance imaging can help confirm the
presence of degenerative tissue in the ECRB muscle
origin and can help diagnose concomitant pathology;however, it is very rarely needed
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Lateral EpicondylopathyLateral Epicondylopathy
Management
Initial goals of pain and inflammation and
strength
Light manual methods such as friction
massage, active release, joint mobilisation,
and Graston technique
Stretching elbow flexion/extension, wristflexion/extension, forearm supination/pronation
for 30 seconds, five repetitions, three times
daily
Management
Initial goals of pain and inflammation and
strength
Light manual methods such as friction
massage, active release, joint mobilisation,
and Graston technique
Stretching elbow flexion/extension, wristflexion/extension, forearm supination/pronation
for 30 seconds, five repetitions, three times
daily
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Carpal Tunnel SyndromeCarpal Tunnel Syndrome
Carpal tunnel
syndrome (CTS) is a
collection of
characteristic
symptoms and signs
that occurs following
entrapment of the
median nerve within
the carpal tunnel
Carpal tunnel
syndrome (CTS) is a
collection of
characteristic
symptoms and signs
that occurs following
entrapment of the
median nerve within
the carpal tunnel
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Carpal Tunnel SyndromeCarpal Tunnel Syndrome
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Carpal Tunnel SyndromeCarpal Tunnel Syndrome
Incidence is 1-3 cases per1000 subjects per year3
Prevalence isapproximately 50 cases
per 1000 subjects in thegeneral population3
Incidence may rise as highas 150 cases per 1000subjects per year, with
prevalence rates greaterthan 500 cases per 1000subjects in certain high-risk groups3
Incidence is 1-3 cases per1000 subjects per year3
Prevalence isapproximately 50 cases
per 1000 subjects in thegeneral population3
Incidence may rise as highas 150 cases per 1000subjects per year, with
prevalence rates greaterthan 500 cases per 1000subjects in certain high-risk groups3
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Carpal Tunnel SyndromeCarpal Tunnel Syndrome
Epidemiology
Female-to-male ratio is 3-10:13
Peak age of development of CTS is from 45-60
years3
Only 10% of CTS patients are younger than 31 years
Epidemiology
Female-to-male ratio is 3-10:13
Peak age of development of CTS is from 45-60
years3
Only 10% of CTS patients are younger than 31 years
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Carpal Tunnel SyndromeCarpal Tunnel Syndrome
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Carpal Tunnel SyndromeCarpal Tunnel Syndrome
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Carpal Tunnel SyndromeCarpal Tunnel Syndrome
Tendons of the following muscles (not the musclesthemselves): Flexor digitorum profundus
Flexor digitorum superficialis
Flexor pollicis longus
Some sources also include the flexor carpi radialis, butit is more precise to state that it travels in the flexorretinaculum which covers the carpal tunnel, rather than
running in the tunnel itself Nerves:
Median nerve b/w tendons of flexor digitorum profundusand flexor digitorum superficialis
Tendons of the following muscles (not the musclesthemselves): Flexor digitorum profundus
Flexor digitorum superficialis
Flexor pollicis longus
Some sources also include the flexor carpi radialis, butit is more precise to state that it travels in the flexorretinaculum which covers the carpal tunnel, rather than
running in the tunnel itself Nerves:
Median nerve b/w tendons of flexor digitorum profundusand flexor digitorum superficialis
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Carpal Tunnel SyndromeCarpal Tunnel Syndrome
Pathophysiology
Median nerve is damaged within the rigid
confines of the carpal tunnel, initially undergoing
demyelination followed by axonal degeneration
Sensory fibers often are affected first, followed
by motor fibers
Autonomic nerve fibers carried in the mediannerve also may be affected.
Pathophysiology
Median nerve is damaged within the rigid
confines of the carpal tunnel, initially undergoing
demyelination followed by axonal degeneration
Sensory fibers often are affected first, followed
by motor fibers
Autonomic nerve fibers carried in the mediannerve also may be affected.
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Carpal Tunnel SyndromeCarpal Tunnel Syndrome
Pathophysiology
Cause of the damage is subject to some
debate; however, it seems likely that abnormally
high carpal tunnel pressures exist in patientswith CTS
Pressure causes obstruction to venous outflow, back
pressure, edema formation, and, ultimately, ischemia
in the nerve
Pathophysiology
Cause of the damage is subject to some
debate; however, it seems likely that abnormally
high carpal tunnel pressures exist in patientswith CTS
Pressure causes obstruction to venous outflow, back
pressure, edema formation, and, ultimately, ischemia
in the nerve
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Carpal Tunnel SyndromeCarpal Tunnel Syndrome
Risk factors include:
Genetic, medical,social, vocational,
avocational, and
demographic
Risk factors include:
Genetic, medical,social, vocational,
avocational, and
demographic
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Carpal Tunnel SyndromeCarpal Tunnel Syndrome
Bilateral CTS is common, although the dominant hand is usually
affected first and more severely than other hand
Complaints should be localized to the palmar aspect of first to
fourth fingers and distal palm (i.e., sensory distribution of the
median nerve at the wrist)
A number of CTS patients are unable to localize their symptoms
further (i.e., whole hand/arm feeling dead)
Pain
Sensory symptoms above commonly are accompanied by an
aching sensation over the ventral aspect of the wrist Pain can radiate distally to palm and fingers or, more
commonly, extend proximally along ventral forearm
Bilateral CTS is common, although the dominant hand is usually
affected first and more severely than other hand
Complaints should be localized to the palmar aspect of first to
fourth fingers and distal palm (i.e., sensory distribution of the
median nerve at the wrist)
A number of CTS patients are unable to localize their symptoms
further (i.e., whole hand/arm feeling dead)
Pain
Sensory symptoms above commonly are accompanied by an
aching sensation over the ventral aspect of the wrist Pain can radiate distally to palm and fingers or, more
commonly, extend proximally along ventral forearm
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Carpal Tunnel SyndromeCarpal Tunnel Syndrome
Autonomic symptoms
Not infrequently, patients report symptoms in the whole hand or
a tight or swollen feeling in the hands
Many patients also report sensitivity to changes in temperature
(particularly cold) and a difference in skin color These symptoms are likely due to autonomic nerve fiber
involvement (the median nerve carries most autonomic fibers to
the whole hand)
Weakness/clumsiness
Loss of power in the hand (particularly for precision gripsinvolving the thumb) does occur; however, in practice, loss of
sensory feedback and pain is often a more important cause of
weakness and clumsiness than loss of motor power per se
Autonomic symptoms
Not infrequently, patients report symptoms in the whole hand or
a tight or swollen feeling in the hands
Many patients also report sensitivity to changes in temperature
(particularly cold) and a difference in skin color These symptoms are likely due to autonomic nerve fiber
involvement (the median nerve carries most autonomic fibers to
the whole hand)
Weakness/clumsiness
Loss of power in the hand (particularly for precision gripsinvolving the thumb) does occur; however, in practice, loss of
sensory feedback and pain is often a more important cause of
weakness and clumsiness than loss of motor power per se
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Carpal Tunnel SyndromeCarpal Tunnel Syndrome
Clinical examination is important to rule out otherneurologic and musculoskeletal diagnoses;however, the examination often contributes little tothe confirmation of the diagnosis of CTS
Sensory examination Abnormalities in sensory modalities may be present on
the palmar aspect of the first 3 digits and radial one halfof the fourth digit
Sensory examination is most useful in confirming thatareas outside the distal median nerve territory arenormal (i.e., thenar eminence, hypothenar eminence,dorsum of first web space)
Clinical examination is important to rule out otherneurologic and musculoskeletal diagnoses;however, the examination often contributes little tothe confirmation of the diagnosis of CTS
Sensory examination Abnormalities in sensory modalities may be present on
the palmar aspect of the first 3 digits and radial one halfof the fourth digit
Sensory examination is most useful in confirming thatareas outside the distal median nerve territory arenormal (i.e., thenar eminence, hypothenar eminence,dorsum of first web space)
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Carpal Tunnel SyndromeCarpal Tunnel Syndrome
Motor examination: Wasting and weakness
of the median-innervated hand muscles
(LOAF muscles) may be detectable
L - First and second lumbricals
O - Opponens pollicis
A - Abductor pollicis brevis
F - Flexor pollicis brevis
Motor examination: Wasting and weakness
of the median-innervated hand muscles
(LOAF muscles) may be detectable
L - First and second lumbricals
O - Opponens pollicis
A - Abductor pollicis brevis
F - Flexor pollicis brevis
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Carpal Tunnel SyndromeCarpal Tunnel Syndrome
Special tests: No good clinical test exists to
support diagnosis of CTS
Hoffmann-Tinel sign
Gentle tapping over the median nerve in the carpal tunnelregion elicits tingling in the nerve's distribution
This sign still is commonly looked for despite the low sensitivity
and specificity
Phalen sign
Tingling in the median nerve distribution is induced by fullflexion (or full extension for reverse Phalen) of the wrists for up
to 60 seconds
This test has 80% specificity but lower sensitivity
Special tests: No good clinical test exists to
support diagnosis of CTS
Hoffmann-Tinel sign
Gentle tapping over the median nerve in the carpal tunnelregion elicits tingling in the nerve's distribution
This sign still is commonly looked for despite the low sensitivity
and specificity
Phalen sign
Tingling in the median nerve distribution is induced by fullflexion (or full extension for reverse Phalen) of the wrists for up
to 60 seconds
This test has 80% specificity but lower sensitivity
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Carpal Tunnel SyndromeCarpal Tunnel Syndrome
Etiology
Demographics:
Increasing age
Female sex
Increased body mass index (BMI), especially recent
increases
Square-shaped wrist
Short stature
Dominant hand
Race (white)
Etiology
Demographics:
Increasing age
Female sex
Increased body mass index (BMI), especially recent
increases
Square-shaped wrist
Short stature
Dominant hand
Race (white)
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Carpal Tunnel SyndromeCarpal Tunnel Syndrome
Genetics:
A strong family susceptibility exists, probably related
to multiple inherited characteristics (i.e., square wrist,
thickened transverse ligament, stature)
A number of inherited medical conditions also are
associated with CTS (i.e., diabetes, thyroid disease,
hereditary neuropathy with liability to pressure
palsies)
Genetics:
A strong family susceptibility exists, probably related
to multiple inherited characteristics (i.e., square wrist,
thickened transverse ligament, stature)
A number of inherited medical conditions also are
associated with CTS (i.e., diabetes, thyroid disease,
hereditary neuropathy with liability to pressure
palsies)
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Carpal Tunnel SyndromeCarpal Tunnel Syndrome
Medical conditions: Wrist fracture (Colles)
Acute severe flexion/extension injury of wrist
Space-occupying lesions within the carpal tunnel (eg, flexortenosynovitis, ganglions, hemorrhage, aneurysms, anomalousmuscles, various tumors, edema)
Diabetes
Thyroid disorders (usually myxoedema)
Rheumatoid arthritis and other inflammatory arthritides of thewrist
Recent menopause (including post-oophorectomy) Renal dialysis
Acromegaly
Amyloidosis
Medical conditions: Wrist fracture (Colles)
Acute severe flexion/extension injury of wrist
Space-occupying lesions within the carpal tunnel (eg, flexortenosynovitis, ganglions, hemorrhage, aneurysms, anomalousmuscles, various tumors, edema)
Diabetes
Thyroid disorders (usually myxoedema)
Rheumatoid arthritis and other inflammatory arthritides of thewrist
Recent menopause (including post-oophorectomy) Renal dialysis
Acromegaly
Amyloidosis
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Carpal Tunnel SyndromeCarpal Tunnel Syndrome
Vocational/avocational: Activities involving (1)prolonged severe force through the wrist, (2)prolonged extreme posture of the wrist, (3) highamounts of repetitive movements, and (4)
exposure to vibration and/or cold may beassociated with CTS (particularly incombination)
Other factors:
Lack of aerobic exercise
Pregnancy and breastfeeding
Use of wheelchairs and/or walking aids
Vocational/avocational: Activities involving (1)prolonged severe force through the wrist, (2)prolonged extreme posture of the wrist, (3) highamounts of repetitive movements, and (4)
exposure to vibration and/or cold may beassociated with CTS (particularly incombination)
Other factors:
Lack of aerobic exercise
Pregnancy and breastfeeding
Use of wheelchairs and/or walking aids
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Carpal Tunnel SyndromeCarpal Tunnel Syndrome
Diagnosis
No blood tests exist for the diagnosis of CTS; however,
laboratory testing for associated conditions (i.e.,
diabetes) may be performed when clinically indicated
No imaging studies are considered routine in diagnosing
CTS
Electrodiagnosis
Electrophysiologic (EDX) studies, including electromyography
(EMG) and nerve conductions studies (NCS), are the first-lineinvestigations in suggested CTS
Diagnosis
No blood tests exist for the diagnosis of CTS; however,
laboratory testing for associated conditions (i.e.,
diabetes) may be performed when clinically indicated
No imaging studies are considered routine in diagnosing
CTS
Electrodiagnosis
Electrophysiologic (EDX) studies, including electromyography
(EMG) and nerve conductions studies (NCS), are the first-lineinvestigations in suggested CTS
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Carpal Tunnel SyndromeCarpal Tunnel Syndrome
Management
Wrist supports
Ultrasound
Exercise
Carpal bone mobilization/manipulation
Surgical intervention
Steroid injection/oral steroids
Management
Wrist supports
Ultrasound
Exercise
Carpal bone mobilization/manipulation
Surgical intervention
Steroid injection/oral steroids
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