Saturday, 23 April 2016

Differential Diagnosis and Treatment of Carpal Tunnel Syndrome

How to differentiate carpal tunnel syndrome with other conditions that have similar symptoms in the hand? Abrasions or bruises on the wrist and hand due to trauma can cause acute injury to the muscle, soft tissue and median or ulnar nerves. Obvious bony deformities of the wrist and fingers such as boutonniere deformity, swan neck deformity and ulnar deviation of the wrist are common in rheumatoid arthritis. Osteoarthritis of the small joints in the hand may present with carpal or phalanx bossing. Severe carpal tunnel syndrome with thumb muscles atrophy usually involve other neuropathy syndromes and carpometacarpal arthritis.

Lifestyle modification is part of the conservative treatments for carpal tunnel syndrome. Constant irritation of the median nerve at the wrist should be minimised. Repetitive motions of the wrist that may be stretching or compressing the median nerve should be avoided. Taking frequent breaks from causative motions helps to alleviate the symptom. Ergonomic equipment such as wrist rest or mouse pad can be utilised to reduce the irritation on the nerve. Frequent keyboard users can look for keyboard alternatives such as a digital pen, voice recognition or dictation software.

Neutral or cock-up wrist splint has shown good results by providing symptoms relief. Physiotherapy and chiropractic treatment are effective in symptom relief. Treatment goals for conservative therapy include pain management, reduce the inflammation, minimise median nerve irritation and maintain the function of the wrist and hand.

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