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Diagnosis of Carpal Tunnel Syndrome
Paula is a 38 year old administrative assistant. She has visited the medical assistant at Heald College Medical Clinic. During the interview with the assistant, Paula explains she was waking up at night with pain in both wrists, Paula also states the wrist pain becomes worse after she has been working on the computer. Paula says she has been using wrist supports but they do not appear to help. The medical assistant refers Paula to the physician. The physician diagnosis is carpal tunnel syndrome. Diabetes, arthritis, is it the underlying cause of Carpal Tunnel Syndrome. Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers (although not the little finger), as well as impulses to some small muscles in the hand that allow the fingers and thumb to move. The carpal tunnel, a narrow rigid passageway of ligament and bones at the base of the hand houses the median nerve and tendons. Thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed. The result may be pain, weakness, or numbness in the hand and wrist radiating up the arm. Although painful sensations may indicate other conditions, carpal tunnel syndrome is the most common and widely known of the entrapping neuropathies in which the body's peripheral nerves are compressed or traumatized. However test will need to be done in order to confirm the diagnosis of carpal tunnel syndrome: Early diagnosis and treatment are important to avoid permanent damage to the median nerve. A physical examination of the hands, arms, shoulders, and neck can help determine if the patient's complaints are related to daily activities or an underlying disorder which can be used as a tool to rule out other painful conditions that mimic carpal tunnel syndrome. The wrist is examined for tenderness, swelling, warmth, and discoloration. Each finger should be tested for sensation, and the muscles at the base of the hand should be examined for strength and signs of atrophy. Routine laboratory tests and X-rays can reveal diabetes, arthritis, and fractures. Physicians can use specific tests to try to produce the symptoms of carpal tunnel syndrome. In the tendon test, the doctor taps on or presses on the median nerve in the patient's wrist. The test is positive when tingling in the fingers or a resultant shock like sensation occurs. The Phalanges, or wrist-flexion, test involves having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together. The presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, are felt in the fingers within 1 minute. Doctors may also ask patients to try to make a movement that brings on symptoms. Often it is necessary to confirm the diagnosis by use of electro diagnostic tests. In a nerve conduction study, electrodes are placed on the hand and wrist. Small electric shocks are applied and the speed with which nerves transmit impulses is measured. In electromyography, a fine needle is inserted into a muscle; Electrical activity viewed on a screen can determine the severity of damage to the median nerve. Ultrasound imaging can show impaired movement of the median nerve. Magnetic resonance imaging (MRI) can show the anatomy of the wrist but to date has not been especially useful in diagnosing carpal tunnel syndrome. Describe the symptoms that occur in carpal tunnel syndrome. Symptoms usually start gradually, with frequent burning, tingling, or itching numbness in the palm of the hand and the fingers,...
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