Review Articles: Current Concepts: Entrapment Neuropathies of the Upper Extremities. Carpal tunnel syndrome in patients who are receiving long-term renal hemodialysis. The carpal tunnel syndrome. A study of carpal canal pressures. Spontaneous rupture of the flexor carpi radialis tendon. Deep postoperative wound infection after carpal tunnel release. Symptomatic restrictive thumb-index flexor tenosynovitis: incidence of musculotendinous … Read more
– See: Anatomy of Carpal Tunnel – TCL Incision: – transverse carpal lig is exposed, but this is generally obscured by origin of thenar & hypothenar muscles, which come to lie in opposition in midline; – palmar fascia is incised, & nerve is identified just proximal to the carpal canal; … Read more
– See: Anatomy of Carpal Tunnel – Anesthesia: – Bier Block: – proponents note that regional anesthesia allows a less rushed operation along w/ a synovectomy, if needed; – median nerve block at elbow; – w/ elbow extended brachial … Read more
– Discussion: – median nerve compression syndrome at the wrist; – most common form of nerve entrapment; – first described by Paget; – references: The First Description of Carpal Tunnel Syndrome. James Paget FRS – pathophysiology: – nerve compression may result in ischemia, focal demyelination, decrease in axonal caliber, and finally axonal loss; – ref: … Read more
– Discussion: – used to image an axial view of the carpal canal with particular attention to the hook of the hamate and pisiform bone; – Technique: – hand is maximally dorsiflexed using the opposite hand or a strap – palmar surface of the wrist rests on … Read more
– Discussion: – average carpal height ratio is 53 % (range, 45-60 %) – carpal height ratio may be used to follow progression of degenerative disease, carpal instability, osteonecrosis, & osteoarthrosis; – decrease in carpal height ratio, indicates carpal collapse; – Measurement: – carpal height is distance … Read more
– See: – Kinematics – Dynamic Instability – Ligaments of the Wrist – Perilunate Dislocations – Instability Patterns: – ulnar translocation: carpus shifts ulnarward (frequently seen in rheumatoid wrist); – dorsal intercalated segment instability; – present when lunate has rotated into dorsiflexion, as seen on lateral x-rays; – capitate displaces dorsal to long axis of … Read more
– Injection of Steroid in pts w/ CTS: – injection of steroids into carpal tunnel can be an effective method of treatment in the short term; – if steroid is injected directly into median nerve, dysesthesias may occur and persist for several weeks; – note that steroid injections into … Read more
Discussion limited fusion of the capitate to the hamate has also been used successfully to prevent carpal collapse; however, following this procedure, grip strength is slow to return; some believe that this is a poor treatment option, since it does not cross both carpal rows, and consequently is ineffective in causing transfer load to the ulnar … Read more
– See: – Radial Ulnar Joints – Rheumatoid Arthritis – Discussion: – ulnar caput syndrome results from synovitis stretching ulnar carpal ligaments; – there is dorsal dislocation of distal ulna, supination of carpus on hand, volar subluxation of the ECU; – left untreated, ulnar translocation … Read more