Carpal Tunnel Syndrome.docx

Carpal tunnel syndrome carpal tunnel sindrom merupakan neuropati perifer fokal yang paling umum terjadi yang merupakan kompresi saraf median di pergelangan tangan.

Clinical Features Nyeri Mati rasa Kesemutan Gejala biasanya lebih buruk di malam hari dan dapat membangunkan pasien dari tidur. Untuk meredakan gejalanya, pasien sering "mengibaskan" pergelangan tangan mereka seolah-olah mengguncang termometer (tanda flick). Nyeri dan parestesia dapat menjalar ke lengan, siku, dan bahu. Kekuatan genggaman yang berkurang dapat menyebabkan hilangnya ketangkasan, dan atrofi otot tenar dapat terjadi jika sindrom sudah parah.

Physical examination Phalen’s maneuver

Tinel’s sign

weak thumb abduction.

two-point discrimination

Diagnostic History Physical examination Nerve Conduction Study Differential Diagnostics Tendonitis Tenosynovitis Diabetic neuropathy Kienbock's disease Compression of the Median nerve at the elbow Treatment Conservative treatments General measures a. Avoid repetitive wrist and hand motions that may exacerbate symptoms or make symptom relief difficult to achieve. b. Not use vibratory tools c. Ergonomic measures to relieve symptoms depending on the motion that needs to be minimized

Wrist splints Probably most effective when it is applied within three months of the onset of symptoms

Oral medications a. Diuretics b. Nonsteroidal anti-inflammatory drugs (NSAIDs) c. pyridoxine (vitamin B6) d. Orally administered corticosteroids a. Prednisolone b. 20 mg per day for two weeks c. followed by 10 mg per day for two weeks Local injection A mixture of 10 to 20 mg of lidocaine (Xylocaine) without epinephrine and 20 to 40 mg of methylprednisolone acetate (Depo-Medrol) or similar corticosteroid preparation is injected with a 25-gauge needle at the distal wrist crease (or 1 cm proximal to it).

Ultrasound therapy Predicting the outcome of conservative treatment Surgery Should be considered in patients with symptoms that do not respond to conservative measures and in patients with severe nerve entrapment as evidenced by nerve conduction studies,thenar atrophy, or motor weakness. It is important to note that surgery may be effective even if a patient has normal nerve conduction studies

Complications of surgery 1. Injury to the palmar cutaneous or recurrent motor branch of the median nerve 2. Hypertrophic scarring 3. laceration of the superficial palmar arch 4. tendon adhesion 5. Postoperative infection

6. Hematoma 7. arterial injury 8. stiffness

wipperman, jennifer and kyle goerl university of kansas school of medicine–wichita, wichita, kansas. am fam physician. 2016 dec 15;94(12):993-999.