Early Stages Management
-Begin conservative therapy.
-a few simple exercises that can easily be done at home. By routinely performing these exercises to warm up the wrist joint, people often avoid the symptoms of carpal tunnel syndrome.
-you should always stretch and warm-up the joint.
-There are ways to maintain the joint in a 'wrist-neutral' position; this decreases the pressure in the carpal tunnel.
-At the keyboard you can use a cushioned "wrist rest
-Use specially modified keyboards and computer mouse are being developed and tested as alternatives to traditional equipment.
Initial Treatment – Anti Inflammatory Medications and Wrist Brace
2nd Step – Cortisone Injections
Surgery
Anti- Inflammatory Medications
NSAIDs (e.g. Motrin or Advil) can decrease inflammation in the carpal tunnel and can also decrease carpal tunnel syndrome symptoms
Wrist Brace
The brace helps to stabilize the carpal tunnel in its neutral position.
The carpal tunnel is at its widest diameter in this position and the nerve is least compressed.
Wearing the splint at night is especially important, as well as during activities that tend to irritate your carpal tunnel syndrome
Cortisone Injection
Cortisone injection to the area to decrease inflammation around the nerve.
The cortisone injection is often effective because the medication is delivered to the source of the problem; however, steroids shoulder be injected sparingly.
Injections of cortisone into the carpal tunnel work about 80% of the time.
However, this relief is often temporary, and the symptoms may return.
Recent research has shown that the carpal tunnel injection is probably an effective treatment for at least one year in many patients.
The injection can also be very helpful in situations where the diagnosis of carpal tunnel syndrome is unclear.
Surgery
The most common procedure is the carpal tunnel release. A carpal tunnel release involves making an incision in the fibrous sheath around the carpal tunnel.
By releasing tension in the carpal tunnel, the pressure is removed from the nerve.
If a carpal tunnel release is done, it is most commonly performed by a "open" technique. To perform an open carpal tunnel release, your surgeon makes a 4 centimeter incision down the middle of the palm. Your surgeon carefully dissects the tissues down to the carpal tunnel. The carpal tunnel is opened up to relieve the pressure on the nerve. The surgery only takes about 15 minutes, and can be performed under local, regional, or general anesthesia.
http://www.youtube.com/watch?v=4vYiqeeUWNU
Endoscopic Carpal Tunnel Release
A carpal tunnel release can now be done through an endoscope. In this procedure, a small (about 1 centimeter) incision is made by the wrist. Through this incision, a small camera is inserted into the carpal tunnel. A small knife attached to the camera is then used to release the carpal tunnel.
Many surgeons prefer the open carpal tunnel release because it is easy to ensure there is adequate relief of tension around the nerve.
Furthermore, the incision from an open carpal tunnel release tends to heal well with few problems.
Some surgeons have also reported complications of the endoscopic carpal tunnel release due to inadvertent cutting of a nerve.
Complications
What are the complications of a carpal tunnel release? 1. injury to the nerve and incision pain.
2. Injury to the nerve usually results in a permanent area of numbness around the base of the thumb; this occurs in about 5-8% of surgeries.
3. Prolonged pain at the site of the incision is uncommon, but can occur in about 1-2% of cases
Carpal Solution Therapy
Worn during sleep, the Carpal Solution gently stretches and reshapes soft tissue in and around the Carpal Tunnel.
It increases flexibility and enhances circulation - thus relieving pressure on the Median Nerve.
Naturally - usually in just a few days
http://www.mycarpaltunnel.com/carpal-tunnel-relief-natural-video.shtml
Friday, August 13, 2010
PCL 4-Fluid retention
Fluid Balance
- The difference between the amount of water taken into the body and the amount excreted or lost.
- a state in which the volume of body water and its solutes (electrolytes and nonelectrolytes) are within normal limits and there is normal distribution of fluids within the intracellular and extracellular compartments
Compartments of body fluid
- Fluid found within the cells is called intracellular fluid (ICF) and that found outside cells is called extracellular fluid (ECF).
- The extracellular fluid is further divided into that which is found as blood plasma within blood vessels, and that which is found in the microscopic spaced between cells called interstitial fluid.
- Approximately 2/3 of body fluid is intracellular and 1/3 is extracellular. Of the ECF approximately 80% is interstitial fluid and 20% is blood plasma.
- There are some special fluid and compartments including: lymph; cerebrospinal fluid; synovial; aqueous humour/vitreous body of the eyes; endolymph/perilymph in the ears; pleural, pericardial and peritoneal fluid between serous membranes; and glomerular filtrate in the kidneys.
- The major components of these fluids include water and solutes. The solute is mostly comprised of electrolytes
Movement of body fluids
- Substances leave and enter capillaries via three mechanisms: vesicular transport, diffusion, and bulk flow.
- Vesicular transport and diffusion are associated with the movement of solutes
- Bulk flow is the movement of both solvent and solute into the interstitial space. Pressures acting to move substances out of the capillary include blood hydrostatic pressure (BHP) and interstitial fluid osmotic pressure (IFOP). Blood colloid osmotic pressure (BCOP) and interstitial fluid hydrostatic pressure act to push substances into the capillary. At the arterial end of the capillary the sum of the outward moving pressures is dominant and substances move into the interstitial fluid (filtration). At the venous end the inward pressure is dominant and the substances move into the capillary (reabsorption).
- The exchange of interstitial and intracellular fluid is controlled mainly by the presence of the electrolytes sodium and potassium. Potassium is the chief intracellular cation and sodium the chief extracellular cation. Because the osmotic pressure of the interstitial space and the ICF are generally equal water typically does not enter or leave the cell. A change in the concentration of either electrolyte will cause water to move into or out of the cell via osmosis. A drop in potassium will cause fluid to leave the cell whilst a drop in sodium will cause fluid to enter the cell. Aldosterone, ANP and ADH regulate sodium levels within the body, whilst aldosterone can be said to regulate potassium
Water retention during premenstrual phase
- Not sure of the real cause
- may be related to hormone fluctuations...
- water retention is part of the premenstrual syndrome (PMS) package. In some women the monthly rise in estrogen turns on the production of the hormone aldosterone. Aldosterone, in turn, causes the kidneys to retain fluids which tends to collect in the breasts and abdomen. Some women gain several pounds during this time.
- Other experts see a sodium link. When your blood breaks down progesterone--as it does a week before your period--your kidneys are prompted to retain both water and sodium. At the same time, a powerful water-retaining substance called anti-diuretic hormone may also be released, further influencing your body to hold onto fluids.
- May be related to blood sugar...
- when a person doesn't eat for many hours, blood sugar gets very low. This causes the body to release adrenaline, which signals the body to let go of some of its stored sugar from cells in order to balance out the blood sugar. When sugar is taken from the cells, they fill up with water, and this is what causes the bloating, weight gain and water retention symptoms in those with PMS.
Water retention during menopause
- Water retention also occurs among women past menopause who take estrogen replacement hormones.
- Hormone Replacement Therapy (HRT) that is taken in a tablet (oral) form, will be absorbed from the intestines and pass immediately through the liver via the liver's portal circulation of blood. Thus the liver may break down a large portion of the hormone dose before it can get into the general circulation to be carried to the body cells.
- This is why higher doses of hormones are required if they are administered in tablet form. In many people this does not cause any problems, whereas in others the liver may either render the hormones ineffective or become overworked by the task of breaking down the hormones.
- In the latter case, side effects such as weight gain, fluid retention, nausea, headaches, high blood pressure or even blood clots may result. In such cases it is best to stop the hormone therapy or change to another form of hormone therapy which is not absorbed from the intestines into the liver.
- It is easy to administer natural hormones in forms that are absorbed directly into the blood circulation before they get to the liver. This enables smaller doses to be used because the hormones have a chance to perform their function on the body cells before the liver breaks them down.
- Often, a women going through menopause and having to deal with water retention will turn to diuretics. Although this is one solution, the problem is that diuretics zap essential potassium from the body. With this, additionally problems associated with osteoporosis can develop.
Where water retention occurs
- Fluid rich with oxygen, vitamins and other nutrients passes all the time from the capillaries (the smallest blood vessels) into the surrounding tissues, where it is known as tissue fluid or interstitial fluid.
- This fluid nourishes the cells and eventually should return to the capillaries. Water retention is said to occur as a result of changes in the pressure inside the capillaries, or changes that make the capillary walls too leaky.
- If the pressure is wrong, or the capillaries are too leaky, then too much fluid will be released into the tissue spaces between the cells. Sometimes so much fluid is released that it cannot all return to the capillaries and remains in the tissues, where it causes the swelling and waterlogging which is experienced as water retention.
- Another set of vessels known as the lymphatic system acts like an "overflow" and can return a lot of excess fluid back to the bloodstream. But even the lymphatic system can be overwhelmed, and if there is simply too much fluid, or if the lymphatic system is congested, then the fluid will remain in the tissues, causing swellings in legs, ankles, feet, abdomen or any other part of the body[
How to Avoid Water Retention
- Pass up drugstore diuretics. Some over-the counter medications intended to relieve menstrual cramp pain also claim to help eliminate premenstrual water weight. Some of these products contain caffeine, which may work as a diuretic.The down side to caffeine, however, is that it also promotes breast pain and tenderness as well as irritability.
- Have some herbal tea. Parsley or uva-ursi tea can help flush out excess water without any harmful side effects. You can find these teas in most health foods stores.
- Check out vitamin B6. Taking up to 250 milligrams of vitamin B6 daily helps reduce premenstrual water retention. This nutrient also reduces fluid build up caused by hormone replacement therapy during menopause. Vitamin B6, however, can be toxic in higher doses and should only be taken under the supervision of a doctor.
- Try calcium. Researchers at the New York Metropolitan Hospital found that a daily calcium supplement provided relief from premenstrual water retention in three-fourths of the women who took it.The best bet is to take a 500-milligram chewable tablet twice daily at breakfast and dinner. Ask your doctor whether these supplements might prove helpful in your case.
- The difference between the amount of water taken into the body and the amount excreted or lost.
- a state in which the volume of body water and its solutes (electrolytes and nonelectrolytes) are within normal limits and there is normal distribution of fluids within the intracellular and extracellular compartments
Compartments of body fluid
- Fluid found within the cells is called intracellular fluid (ICF) and that found outside cells is called extracellular fluid (ECF).
- The extracellular fluid is further divided into that which is found as blood plasma within blood vessels, and that which is found in the microscopic spaced between cells called interstitial fluid.
- Approximately 2/3 of body fluid is intracellular and 1/3 is extracellular. Of the ECF approximately 80% is interstitial fluid and 20% is blood plasma.
- There are some special fluid and compartments including: lymph; cerebrospinal fluid; synovial; aqueous humour/vitreous body of the eyes; endolymph/perilymph in the ears; pleural, pericardial and peritoneal fluid between serous membranes; and glomerular filtrate in the kidneys.
- The major components of these fluids include water and solutes. The solute is mostly comprised of electrolytes
Movement of body fluids
- Substances leave and enter capillaries via three mechanisms: vesicular transport, diffusion, and bulk flow.
- Vesicular transport and diffusion are associated with the movement of solutes
- Bulk flow is the movement of both solvent and solute into the interstitial space. Pressures acting to move substances out of the capillary include blood hydrostatic pressure (BHP) and interstitial fluid osmotic pressure (IFOP). Blood colloid osmotic pressure (BCOP) and interstitial fluid hydrostatic pressure act to push substances into the capillary. At the arterial end of the capillary the sum of the outward moving pressures is dominant and substances move into the interstitial fluid (filtration). At the venous end the inward pressure is dominant and the substances move into the capillary (reabsorption).
- The exchange of interstitial and intracellular fluid is controlled mainly by the presence of the electrolytes sodium and potassium. Potassium is the chief intracellular cation and sodium the chief extracellular cation. Because the osmotic pressure of the interstitial space and the ICF are generally equal water typically does not enter or leave the cell. A change in the concentration of either electrolyte will cause water to move into or out of the cell via osmosis. A drop in potassium will cause fluid to leave the cell whilst a drop in sodium will cause fluid to enter the cell. Aldosterone, ANP and ADH regulate sodium levels within the body, whilst aldosterone can be said to regulate potassium
Water retention during premenstrual phase
- Not sure of the real cause
- may be related to hormone fluctuations...
- water retention is part of the premenstrual syndrome (PMS) package. In some women the monthly rise in estrogen turns on the production of the hormone aldosterone. Aldosterone, in turn, causes the kidneys to retain fluids which tends to collect in the breasts and abdomen. Some women gain several pounds during this time.
- Other experts see a sodium link. When your blood breaks down progesterone--as it does a week before your period--your kidneys are prompted to retain both water and sodium. At the same time, a powerful water-retaining substance called anti-diuretic hormone may also be released, further influencing your body to hold onto fluids.
- May be related to blood sugar...
- when a person doesn't eat for many hours, blood sugar gets very low. This causes the body to release adrenaline, which signals the body to let go of some of its stored sugar from cells in order to balance out the blood sugar. When sugar is taken from the cells, they fill up with water, and this is what causes the bloating, weight gain and water retention symptoms in those with PMS.
Water retention during menopause
- Water retention also occurs among women past menopause who take estrogen replacement hormones.
- Hormone Replacement Therapy (HRT) that is taken in a tablet (oral) form, will be absorbed from the intestines and pass immediately through the liver via the liver's portal circulation of blood. Thus the liver may break down a large portion of the hormone dose before it can get into the general circulation to be carried to the body cells.
- This is why higher doses of hormones are required if they are administered in tablet form. In many people this does not cause any problems, whereas in others the liver may either render the hormones ineffective or become overworked by the task of breaking down the hormones.
- In the latter case, side effects such as weight gain, fluid retention, nausea, headaches, high blood pressure or even blood clots may result. In such cases it is best to stop the hormone therapy or change to another form of hormone therapy which is not absorbed from the intestines into the liver.
- It is easy to administer natural hormones in forms that are absorbed directly into the blood circulation before they get to the liver. This enables smaller doses to be used because the hormones have a chance to perform their function on the body cells before the liver breaks them down.
- Often, a women going through menopause and having to deal with water retention will turn to diuretics. Although this is one solution, the problem is that diuretics zap essential potassium from the body. With this, additionally problems associated with osteoporosis can develop.
Where water retention occurs
- Fluid rich with oxygen, vitamins and other nutrients passes all the time from the capillaries (the smallest blood vessels) into the surrounding tissues, where it is known as tissue fluid or interstitial fluid.
- This fluid nourishes the cells and eventually should return to the capillaries. Water retention is said to occur as a result of changes in the pressure inside the capillaries, or changes that make the capillary walls too leaky.
- If the pressure is wrong, or the capillaries are too leaky, then too much fluid will be released into the tissue spaces between the cells. Sometimes so much fluid is released that it cannot all return to the capillaries and remains in the tissues, where it causes the swelling and waterlogging which is experienced as water retention.
- Another set of vessels known as the lymphatic system acts like an "overflow" and can return a lot of excess fluid back to the bloodstream. But even the lymphatic system can be overwhelmed, and if there is simply too much fluid, or if the lymphatic system is congested, then the fluid will remain in the tissues, causing swellings in legs, ankles, feet, abdomen or any other part of the body[
How to Avoid Water Retention
- Pass up drugstore diuretics. Some over-the counter medications intended to relieve menstrual cramp pain also claim to help eliminate premenstrual water weight. Some of these products contain caffeine, which may work as a diuretic.The down side to caffeine, however, is that it also promotes breast pain and tenderness as well as irritability.
- Have some herbal tea. Parsley or uva-ursi tea can help flush out excess water without any harmful side effects. You can find these teas in most health foods stores.
- Check out vitamin B6. Taking up to 250 milligrams of vitamin B6 daily helps reduce premenstrual water retention. This nutrient also reduces fluid build up caused by hormone replacement therapy during menopause. Vitamin B6, however, can be toxic in higher doses and should only be taken under the supervision of a doctor.
- Try calcium. Researchers at the New York Metropolitan Hospital found that a daily calcium supplement provided relief from premenstrual water retention in three-fourths of the women who took it.The best bet is to take a 500-milligram chewable tablet twice daily at breakfast and dinner. Ask your doctor whether these supplements might prove helpful in your case.
PCL 5 - Physical Examination of Hands & Wrists
History
Pain
- vague/diffused → radiated from shoulder or neck / carpal tunnel syndrome
- localised → arthritis
Stiffness
- worse in mornings for rheumatoid arthritis
Swelling
- wrist → arthritis / tendon sheath inflammation
- individual joints → arthritis
Deformity
- fingers & hand → rheumatoid arthritis
- fingers → arthritis / gouty tophi (tohpi - nodular masses of uric acid crystals deposited in different soft tissue areas in body, most commonly fingers, elbow and big toe)
- sudden onset of deformity → tendon rupture
Locking or snapping of finger (trigger finger)
- inflammation of flexor tendon sheath (tenovaginitis)
Loss of function
- history should include assessment of difficulties patient has in using hands and wrists
Neurological symptoms due to nerve compression
- paraesthesiae (abnormal skin sensations (as tingling or tickling or itching or burning)
usually associated with peripheral nerve damage)- limitation of complicated hand functions
Examination
- sit patient over side of bed and place hands of pillows with palms down
LOOK
→ wrists & forearms
- erythema
- atrophy
- scars
- rashes
- swelling and its distribution
- deformity
- ulnar and hyloid prominence
- muscle wasting of intrinsic muscles of hand (appearance of hollow ridges between metacarpal bones)
→ metacarpophalangeal joints
skin abnormalities
swelling
deformity
ulnar deviation & volar (palmar) subluxation of fingers (characteristic of rheumatoid arthritis (RA) but NOT pathognomonic)
→ proximal & distal interphalangeal joints (IPJ)
skin changes & joint swelling
characteristic deformities of RA
- swan neck (hyperextension at proximal IPJ (subluxation) & fixed flexion deformity at distal IPJ (tendon shortening))
- boutonniere deformity (fixed flexion of proximal IPJ & fixed extension of distal IPJ)
- Z deformity of thumb (hyperextension of IPJ & fixed flexion and subluxation of metacarpophalangeal joint)
characteristic changes of osteoarthritis (OA)
- Heberden's nodes (osteophytes at distal IPJ)
- Bouchard's nodes (osteophytes at proximal IPJ)
→ nails
characteristic psoriatic nail changes (nail disease common in those suffering from psoriasis)
- pitting (small depressions in nails)
- onycholysis
- hyperkeratosis (thickening of nail)
- ridging & discolouration
→ palmar surface (hands turned over)
scars (from tendon repairs or transfers)
erythema
muscle wasting of thenar (the fleshy area of the palm at the base of the thumb) / hypothenar (group of three muscles of the palm that control the motion of the little finger)eminences (due to disuse, vasculitis, peripheral nerve entrapment)
FEEL & MOVE
(palm down position)
→ palpate wrists (both thumbs placed on dorsal surface by the wrists supported underneath by index fingers)
- feel gently for synovitis (boggy swelling) & effusions
- dorsiflex wrists gently (normal – possible to 75 degrees) & palmar flex (possible to 75
degrees) with examiner's thumbs- test radial and ulnar deviation (20 degrees)
- note tenderness / limitation of movement / joint crepitus
- palpate ulnar styloid for tenderness (can occur in RA)
- palpate tip of radial styloid for tenderness (de Quervain's tenosynovitis)
- tenderness in anatomical snuff box (scaphoid injury)
- tenderness distal to head of ulna for extensor carpi ulnaris tendonitis
→ metacarpophalangeal joints (MCPJ) (both thumbs)
flex MCPJ with proximal phalanx held between thumb & forefinger → rock MCPJ backwards & forwards
normal joint – very little movement
ligamentous laxity / subluxation – considerable movement
→ interphalangeal joints (proximal & distal)
palpate for tenderness , swelling, osteophytes
→ palmar tendon crepitus
palmar aspects of examiner's fingers placed against palm of patient's hands while he / she flexes and extends the MCPJs
tenosynovitis – inflamed palmar tendons can be felt creaking in their thickened sheaths and nodules can be palpated
→ trigger finger
same manoeuvre as for palmar tendon crepitus
RA → thickening of a section of digital flexor tendon is such that it tends to jam when passing through a narrowed part of its tendon sheath
flexion of finger occurs freely up to a certain point where it sticks and cannot be extended (flexors are more powerful than extensors)
application of greater force overcomes the resistance with a snap
→ carpal tunnel syndrome
flex both wrists for 30 seconds (Phalen's wrist flexion test)
if syndrome is present – paraesthesiae (pins & needles) precipitated in affected hand in distribution of median nerve
more reliable than Tinel's sign (tapping over the flexor retinaculum which lies at the proximal part of the palm – produce similar paraesthesiae)
→ test active movements
- wrist flexion and extension
- compare both sides
- test passive movements
→ thumb movements (hand flat, palm upwards & examiner's hand holds patient's fingers)
- extension (stretch thumb outwards)
- abduction (thumb pointed straight upwards)
- adduction (asking patient to squeeze examiner's fingers)
- opposition (get the patient to touch little finger with the thumb)
*look for limitation of these movements and discomfort caused by them
→ metacarpophalangeal & interphalangeal movements
- ask patient to make a fist then to straighten out the fingers
- test fingers individually
- if active flexion of one or more fingers is reduced → test superficialis and profundus flexor tendons
- hold proximal finger joint extended and istruct patient to bend it
- distal fingertip will flex if flexor profundus is intact
- hold other fingers extended (to inactivate the profundus) and check finger flexion (inability – supercialis unable to work)
3. FUNCTION
- grip strength
- getting patient to squeeze two of the examiner's fingers
- key grip
- hold key between the pulps of thumb and forefinger
- ask patient to hold his grip tightly and try to open up his or her fingers
- opposition strength
- patient opposes thumb and individual fingers
- difficulty by which these can be forced apart is assessed
- practical test
- ask patient to undo a button / write a pen
- completed by formally assessing for neurological changes
Videos
http://www.youtube.com/watch?v=ysWOHe4dfpI
OR
http://www.youtube.com/watch?v=65mjCLGrGTE&p=53CC110348635B55&playnext=1&index=52
Thursday, August 12, 2010
PCL 5- Carpal Tunnel Syndrome Investigation
Carpal Tunnel Investigations
An early diagnosis and appropriate treatment may aid a rapid return to normal function and avoid permanent damage to the median nerve.
Some doctor's feel that the clinical symptoms and the physical signs that they elicit are so classic of carpal tunnel syndrome they will offer the patient treatment on this basis
If there is any suggestion of any cause for the carpal tunnel syndrome this may be investigated.
1. Blood tests to exclude diabetes, thyroid problems, rheumatoid arthritis.
2. Plain x-rays can be obtained if there is a suggestion of an old bone abnormality.
The most common investigation for carpal tunnel syndrome:
Nerve conduction studies/ Electroneurography (ENG)
These are electro-diagnostic tests. In this investigation small electrodes are placed on the hand, wrist and tips of fingers. Small electrical current shocks are then applied to the electrodes and the speed in which the nerve travels through the carpal tunnel can be recorded. This can be compared with the opposite side or if a patient has symptoms in both sides, can be compared with a large database of normal individuals that is stored centrally
85% sensitivity and specificity greater than 95% for diagnosing CTS.
Electromyography (EMG)
Very occasionally further tests can be performed inserting tiny needles into the muscles of the base of the thumb to assess muscle damage. However this is rarely undertaken for a classic carpal tunnel syndrome.
Useful in some cases but is not as sensitive as ENG
Ultrasonography
This is being used increasingly as a confirmatory test. Enthusiasts cite its wide availability, lower cost, noninvasiveness, and shorter examination time than electrophysiological studies. Ultrasound views of the median nerve show widening at the inlet of the carpal tunnel or flattening along the length of the tunnel
MRI scan- this can be used as an alternative to ultrasonography and when electrophysiological studies are ambiguous.7
These are useful in patients whose clinical features yield a high index of suspicion for carpal tunnel syndrome (CTS) but who fail to respond to first-line treatment.9
There is increasing evidence that nerve conduction studies performed before treatment can give a guide as to future outcomes of further surgery if initial surgery has not been successful.
Wednesday, August 11, 2010
PCL5- Signs and Symptoms of Carpal Tunnel Syndrome
Signs and Symptoms
- Pain, Numbness and tingling of the palmar surface of any of the five digits, except for the little finger.
- Sensations are often more pronounced at night and can awaken people from sleep- Due to flexed-wrist sleeping position and/or fluid accumulating around the wrist and hand while lying flat.
- May also experience pain in the elbow or shoulder, as fibers of the median nerve originate from the spinal cord in the neck and travel through the shoulder and elbow areas.
- Repetitive use activities involving the hands often initiate or worsen the symptoms.
- As the disease progresses, patients can develop a burning sensation, and/or cramping and weakness of the hand- Decreased grip strength can lead to frequent dropping of objects from the hand.
- Chronic carpal tunnel syndrome can also lead to atrophy of the hand muscles, particularly those near the base of the thumb in the palm of the hand. (Thenar muscles)
- Pain, Numbness and tingling of the palmar surface of any of the five digits, except for the little finger.
- Sensations are often more pronounced at night and can awaken people from sleep- Due to flexed-wrist sleeping position and/or fluid accumulating around the wrist and hand while lying flat.
- May also experience pain in the elbow or shoulder, as fibers of the median nerve originate from the spinal cord in the neck and travel through the shoulder and elbow areas.
- Repetitive use activities involving the hands often initiate or worsen the symptoms.
- As the disease progresses, patients can develop a burning sensation, and/or cramping and weakness of the hand- Decreased grip strength can lead to frequent dropping of objects from the hand.
- Chronic carpal tunnel syndrome can also lead to atrophy of the hand muscles, particularly those near the base of the thumb in the palm of the hand. (Thenar muscles)
Sunday, August 8, 2010
Zaharah's Pin and Needles ! = |
Zaharah’s Pins and Needles
- Writer
- Feelings pins and needles in her right hand ( except little finger)
- Put on 20kg’s
- Spoke to her sister about it
- Happens at night
- Feelings goes away when she shakes her hands
- Median Nerve ?
- Neuropathic Pain
Risk Factors
- Typing a lot recently
- Some Carpal Tunnel ( anatomical variation )
- Injury in the wrist
- Fluid retention during pregnancy ( cardiac output to be increased )
- Rheumatoid Arthritis
- Hypothyroidism
- Lack of growth hormone
Learning Issues
- fluid balance? Where is the fluid? - Revathy
- Why fluid retention in the pre-menstrual phase, menopausal women. Revathy
- What is carpal tunnel syndrome? Pathophysiology - Gurki
- Anatomy of the wrist , retinaculum - Dev and Deena
- Signs and Symptoms - Amlah
- Causes and Risk factors? - Jon
- Epidemiology - Rezza
- Differential Diagnosis - Rezza
- Investigations - Teh
- Treatment and management – Jin Li
- Prognosis - Jon
- Median Nerve/ Ulnar Nerve function (motor and sensory ) - Nicole
- Movements possible at the joints ( condyloid and saddle thumbs mainly , affected by
carpal tunnel syndrome? ) - Valerie and Lincoln
- Ulnar Nerve “Syndrome” – Sharvin
- Physical Examination – Charlene !
- Writer
- Feelings pins and needles in her right hand ( except little finger)
- Put on 20kg’s
- Spoke to her sister about it
- Happens at night
- Feelings goes away when she shakes her hands
- Median Nerve ?
- Neuropathic Pain
Risk Factors
- Typing a lot recently
- Some Carpal Tunnel ( anatomical variation )
- Injury in the wrist
- Fluid retention during pregnancy ( cardiac output to be increased )
- Rheumatoid Arthritis
- Hypothyroidism
- Lack of growth hormone
Learning Issues
- fluid balance? Where is the fluid? - Revathy
- Why fluid retention in the pre-menstrual phase, menopausal women. Revathy
- What is carpal tunnel syndrome? Pathophysiology - Gurki
- Anatomy of the wrist , retinaculum - Dev and Deena
- Signs and Symptoms - Amlah
- Causes and Risk factors? - Jon
- Epidemiology - Rezza
- Differential Diagnosis - Rezza
- Investigations - Teh
- Treatment and management – Jin Li
- Prognosis - Jon
- Median Nerve/ Ulnar Nerve function (motor and sensory ) - Nicole
- Movements possible at the joints ( condyloid and saddle thumbs mainly , affected by
carpal tunnel syndrome? ) - Valerie and Lincoln
- Ulnar Nerve “Syndrome” – Sharvin
- Physical Examination – Charlene !
Sunday, August 1, 2010
PCL 4- Differential Diagonsis(Tendonitis,Bursitis and Impingement Syndrome)
Hey ppl!
Sorry i posted it up so late!!
i was held up with stuff over the weekend :/ sorry again :)
see u guys soon! :)
Sorry i posted it up so late!!
i was held up with stuff over the weekend :/ sorry again :)
see u guys soon! :)
Tendonitis
The tendons become inflamed and the action of pulling the muscle becomes irritating. If the normal smooth gliding motion of your tendon is impaired, the tendon will become inflamed and movement will become painful. This is called tendonitis, and literally means inflammation of the tendon.
Tendonitis can occur in any tendon in the body, but tends to occur in one of a small handful of the hundreds of tendons scattered throughout our body.
Types of Tendonitis
Wrist Tendonitis
· common problem that can cause pain and swelling around the wrist
· due to inflammation of the tendon sheath
· Wrist tendonitis usually does not require surgery.
Achilles Tendonitis
· Causes pain and swelling in the back of the heel.
·
Posterior Tibial Tendonitis
· Occurring near Achilles tendonitis, but is less common,
· If left untreated, posterior tibial tendonitis can result in a flat foot.
Patellar Tendonitis.
· Inflammation of the patellar tendon.
· Treatment of patellar tendonitis usually consists of rest and anti-inflammatory medication.
Rotator Cuff Tendonitis
· Inflammation of the tendons of the shoulder muscles can occur in sports requiring the arm to be moved over the head repeatedly.
· Chronic inflammation or injury can cause the tendons of the rotator cuff to tear.
· Pain associated with arm movement
· Pain in the shoulder at night, especially when lying on the affected shoulder
· Weakness with raising the arm above the head, or pain with overhead activities
Lateral Epicondylitis
· Type of tendonitis that causes pain over the outside of the elbow.
· Can occur in people who perform other sports or repetitive activities of the wrist and elbow.
Bursitis
Bursitis is inflammation of a bursa. A bursa is a tiny fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body.
A bursa can become inflamed from injury, infection (rare in the shoulder), or due to an underlying rheumatic condition.
Bursitis is identified by
· localized pain
· swelling
· tenderness
· Pain with motion of the tissues in the affected area.
Impingement Syndrome
- caused by the tendons of the rotator cuff becoming 'impinged' as they pass through a narrow bony space called the Subacromial space.
- With repetitive pinching, the tendon(s) become irritated and inflamed.
- can lead to thickening of the tendon which may cause further problems because there is very little free space, so as the tendons become larger, they are impinged further by the structures of the shoulder joint and the muscles themselves.
- Impingement Syndrome in itself is not a diagnosis, it is a clinical sign.
- If left untreated, shoulder impingements can result in a rotator cuff tear.
- Impingement Syndrome could be classified as external (either primary or secondary) or internal.
Symptoms
- Shoulder pain comes on gradually over a long period.
· Pain at the front and/or side of the shoulder joint with overhead activity
· Pain at the back and/or front of the shoulder when the arm is held out to the side (abducted) and turned outwards (external rotation)
· Pain when lifting the arm above 90 degrees
· Pain on internal (medial rotation) movements
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