Peripheral neuropathy objective 3 (cts)
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Transcript of Peripheral neuropathy objective 3 (cts)
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Peripheral neuropathy.Turki M. Alanazi
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Objectives •Enumerate sites of peripheral nerve
compression and discuss features of carpal tunnel syndrome.
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Sites of peripheral nerve compression
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Carpal Tunnel Syndrome.•Most common entrapment neuropathy.• Female to Male ration = 4:1•Compression of the Median Nerve at the wrist
by the Transverse Carpal Ligament.
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Carpal Tunnel Syndrome.• Idiopathic cause but it is associated with ..▫Occupation.▫Hypothyroidism▫Diabetes mellitus▫Pregnancy (third trimester)▫Obesity. ▫Rheumatoid disease▫ Acromegaly▫amyloid▫Renal dialysis patients.
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Clinical Features • Pain or paresthesia (numbness and tingling) in the first
three digits and the radial half of the fourth digit ( 3.5) patient awakened at night, the pain is relieved by shaking or
rubbing. •Sensory loss in median nerve distribution i.e. radial 3.5
digits.•Weakness and wasting of Thenar muscles ( late
feature).• Positive Tinel’s sign. • Positive Phalen’s sign.
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Tinel’s sign
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Phalen’s maneuver/sign
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CTS Treatment
•Most cases of CTS can be adequately treated with conservative (i.e. non-surgical) management.▫Rest
avoid repetitive wrist and hand motion, wrist splints when repetitive wrist motion required.
▫Wrest splint night time splinting to keep wrist in neutral position.
▫Medications NSAIDs, local corticosteroids injection, oral
corticosteroids
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Surgical treatment of CTS• Indications for surgery:
Numbness and tingling ± sensory loss. Weakness ± muscle atrophy. Unresponsive to conservative measures.
Open Endoscopic
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Summary • Sites of peripheral neuropathies
• Pain or paresthesia (numbness and tingling) in the first three digits and the radial half of the fourth digit ( 3.5).
• Sensory loss in median nerve distribution i.e. radial 3.5 digits.
•Weakness and wasting of Thenar muscles ( late feature).
• Positive Tinel’s sign. • Positive Phalen’s sign.
Clinical features of CTS
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References
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