00:01
How do we manage carpal tunnel syndrome?
Medically,
we offer occupational and physical therapy.
00:10
Wrist splinting to a neutral
position may be helpful.
00:14
Remember those wrist rests
that people use on keyboards.
00:18
It’s partly to try to reduce the
incidence of carpal tunnel syndrome.
00:22
Sometimes, steroid is injected
into the region for symptomatic relief
If necessary, or the clinical symptoms deteriorate,
we can offer surgery.
00:35
This is usually for the patients who have
severe carpal tunnel syndrome.
00:39
Severe carpal tunnel syndrome can be
described by EMG (or electromyographs).
00:47
Here, we evaluate the
actual conduction of the nerve
and whether or not there's truly
compression of the median nerve.
00:54
We release the transverse ligament,
allowing the carpal tunnel syndrome
to relieve in terms of symptoms,
but it may not be as helpful
if the previous EMG demonstrates that
there was now full compression
of the median nerve.
01:10
Here's that demonstration of the EMG.
01:13
Multiple electrodes are placed over the
distributions of the median and radial nerves.
01:20
Here's a picture of a
transverse ligament release.
01:23
Note the palmar area is exposed surgically.
01:28
With full release of the transverse ligament,
the median nerve should
no longer be compressed.
01:32
Symptomatic relief is
usually fairly immediate.
01:40
Now, let's visit some important
clinical pearls and high-yield information.
01:45
Individually, each of the classic physical signs has
low sensitivity and specificity for carpal tunnel.
01:51
As a unit, it’s usually highly diagnostic.
01:55
Remember the classic presentation
and don't forget the distribution
of the median nerve.
02:03
Sensory loss with median nerve impingement,
again, to remind you
include palmar aspects
of digits one, two and three
and the radial half of the fourth digit.
02:12
Thank you for joining me in this discussion of carpal tunnel syndrome.