Soft Tissue

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    Carpal Tunnel

    • Compression of the median nerve
    • Most common: white, middle-aged women. 
    • Symptoms:
      • Pain, numbless, tingling, swelling and weakness in the medial nerve distribution
      • Classically:
        • 2-3 first fingers of the hand (Sn 64%, Sp 73%)
        • Flick Sign (relief of symptoms when flicking or shaking hands when pt awakes @ night) (Sn 93%, Sp 95%)
    • Physical Exam (focused)
      • Phalen Sign (Sn 57-91%, Sp 33-86%)
      • Tinel Sign (Sn 23-60%, Sp 64-87%)
      • Carpal Compression Test (Durkan) (Sn 75%, Sp 98%)
    • Treatment
      • Non-Surgical (for mild-to-mod sx)
        • Splinting (in a neutral position) nightly x6 weeks.
          • Full-Time Splinting or nightly x3mo is even better!! (new studies 2016)
        • Glucocorticoids
          • Inject locally into carpal tunnel (temporary)
          • Systemic has been used, and has some efficacy. 
        • NSAIDs, Diuretics, Vitamin B6 --> NOT effective in trials
      • Surgical
        • Carpal tunnel release
    • Source: NEJM Plus - accessed 2016
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