Carpal Tunnel Syndrome: Diagnosis & Treatment

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Carpal Tunnel Syndrome is primarily caused by the entrapment of which nerve in the wrist?

Radial nerve
Ulnar nerve
Axillary nerve
Median nerve (correct)

Which of the following is NOT typically considered an etiological factor for Carpal Tunnel Syndrome?

Acute bacterial infection (correct)
Repetitive movements
Hypothyroidism
Obesity

A positive Phalen's test in a physical examination suggests Carpal Tunnel Syndrome. How is this test typically performed?

Applying direct pressure to the carpal tunnel for one minute.
Having the patient extend their wrist against resistance.
Having the patient flex their wrists and hold them together for one minute. (correct)
Tapping lightly over the median nerve at the wrist to elicit pain.

When evaluating a patient for possible Carpal Tunnel Syndrome, which of the following differential diagnoses should be considered to rule out other conditions?

Cervical radiculopathy (D) Signup and view all the answers

Initial non-pharmacologic treatment options for Carpal Tunnel Syndrome typically include all of the following EXCEPT:

Systemic antibiotics (A) Signup and view all the answers

Which diagnostic tool is considered most definitive in confirming a diagnosis of Carpal Tunnel Syndrome?

Electromyography and nerve conduction studies (C) Signup and view all the answers

A patient with Carpal Tunnel Syndrome has been using a wrist splint and taking NSAIDs for three months without significant improvement. What is the MOST appropriate next step in management?

Refer the patient to an orthopedist or hand specialist. (B) Signup and view all the answers

What is the primary purpose of carpal tunnel release surgery?

To reduce pressure on the median nerve. (D) Signup and view all the answers

What does 'entrapment neuropathy' refer to in the context of Carpal Tunnel Syndrome?

Compression or squeezing of a nerve, specifically the median nerve. (C) Signup and view all the answers

Which of the following conditions is LEAST likely to be mistaken for Carpal Tunnel Syndrome during diagnosis?

Hypothyroidism (B) Signup and view all the answers

A patient reports experiencing symptoms of Carpal Tunnel Syndrome primarily during the night. What initial non-pharmacologic intervention is MOST likely to provide relief?

Wearing a wrist splint during sleep (C) Signup and view all the answers

Which of the following physical exam findings would be LEAST indicative of Carpal Tunnel Syndrome?

Full, pain-free range of motion in the wrist (D) Signup and view all the answers

What is the primary rationale for advising 'work-home modification' as a non-pharmacological treatment for Carpal Tunnel Syndrome?

To reduce repetitive strain on the wrist and hand (B) Signup and view all the answers

A patient presents with suspected Carpal Tunnel Syndrome, but also has signs of cervical radiculopathy. What diagnostic step would be MOST helpful in differentiating between these two conditions?

Electromyography (EMG) and nerve conduction studies (D) Signup and view all the answers

A patient with Carpal Tunnel Syndrome has not responded to conservative treatments after 10 weeks. According to the guidelines, what would be the MOST appropriate next step?

Referral to an orthopedist or hand specialist (C) Signup and view all the answers

Which of the following is the MOST direct physiological effect of a corticosteroid injection in the carpal tunnel for treating Carpal Tunnel Syndrome?

To reduce inflammation around the median nerve (C) Signup and view all the answers

Why might a physician order lab tests such as TSH, RF, and ANA when evaluating a patient for possible Carpal Tunnel Syndrome?

To rule out underlying systemic conditions contributing to the symptoms (C) Signup and view all the answers

What is the MOST likely reason for a surgeon to perform an open carpal tunnel release rather than an endoscopic release?

Open release allows for better visualization and management of anatomical variations or complications. (D) Signup and view all the answers

Why is electromyography (EMG) and nerve conduction studies often used in diagnosing carpal tunnel syndrome?

To measure the electrical activity of muscles and nerves, helping to confirm median nerve entrapment and rule out other neuropathies. (D) Signup and view all the answers

A patient presents with thenar muscle atrophy in addition to classic Carpal Tunnel Syndrome symptoms. What does this indicate regarding the condition?

The median nerve compression has been present long enough to cause muscle wasting, indicating a more severe or chronic case. (A) Signup and view all the answers

What is the underlying principle behind using a wrist splint as a non-pharmacological treatment for Carpal Tunnel Syndrome?

To immobilize the wrist, reducing median nerve compression and inflammation. (C) Signup and view all the answers

If a patient with suspected Carpal Tunnel Syndrome also has neck pain and tingling radiating into multiple fingers, why is cervical radiculopathy considered in the differential diagnosis?

Cervical radiculopathy can cause similar sensory symptoms in the hand and fingers due to nerve compression in the neck. (D) Signup and view all the answers

How do oral corticosteroids aim to alleviate symptoms of Carpal Tunnel Syndrome?

By reducing overall inflammation, which can decrease swelling around the median nerve. (D) Signup and view all the answers

Why might a physician recommend laboratory tests such as TSH (thyroid-stimulating hormone) when evaluating a patient for Carpal Tunnel Syndrome?

Undetected thyroid issues can contribute to fluid retention, leading to pressure on the median nerve within the carpal tunnel. (D) Signup and view all the answers

What is the primary goal of physical therapy, specifically ultrasound therapy, in treating carpal tunnel syndrome?

To reduce inflammation and promote tissue healing around the carpal tunnel. (A) Signup and view all the answers

A patient reports symptom relief with wrist splinting at night but experiences worsening symptoms during the day at work, despite ergonomic adjustments. What is the MOST appropriate next step?

Refer the patient for corticosteroid injection or surgical evaluation. (D) Signup and view all the answers

Which of the following best explains the rationale behind recommending work-home modifications for managing Carpal Tunnel Syndrome?

To reduce repetitive movements and sustained postures that exacerbate nerve compression and inflammation. (C) Signup and view all the answers

A patient who is 7 months pregnant presents with signs and symptoms suggestive of Carpal Tunnel Syndrome. What is the MOST appropriate initial treatment approach, considering her pregnancy?

Initiation of wrist splinting and trials of rest with work-home modifications. (A) Signup and view all the answers

An electrician reports experiencing persistent symptoms of Carpal Tunnel Syndrome despite consistent use of wrist splints and appropriate work modifications for the past 8 weeks. What would be the MOST appropriate next step in managing his condition?

Referral to a hand specialist for consideration of corticosteroid injection or surgical evaluation. (D) Signup and view all the answers

During a physical examination for suspected Carpal Tunnel Syndrome, you perform Phalen's test and Tinel's sign, both eliciting symptoms. However, the patient also reports neck pain and tingling radiating into the same arm. What condition should be high in the differential diagnosis?

Cervical radiculopathy. (B) Signup and view all the answers

A 55-year-old patient with a history of diabetes and hypothyroidism presents with signs and symptoms of Carpal Tunnel Syndrome. Besides physical examination, which of the following diagnostic tests would be MOST beneficial in evaluating potential contributing factors?

CBC, ESR, RF, ANA and TSH lab tests. (D) Signup and view all the answers

A patient diagnosed with Carpal Tunnel Syndrome is considering carpal tunnel release surgery. What information would be MOST important to emphasize when counseling the patient about the expected outcomes and potential limitations of the procedure?

While surgery typically relieves nerve compression, complete resolution of symptoms and return of full function can vary, and some symptoms might persist. (C) Signup and view all the answers

Carpal Tunnel Syndrome

Repetitive stress injury causing median nerve entrapment at the wrist.

CTS Etiologies

Repetitive movements, pregnancy, obesity, arthritis, diabetes mellitus, hypertension, hypothyroidism and trauma.