User:Saltrabook/Clinical diagnostic guidelines/Ocupational musculoskeletal diseases/Carpal Tunnel Syndrome

Definition


Compression of n. Median in the carpal tunnel, which is a narrow channel bounded by håndrodsknoglerne and a ligament (flexorretinaklet). Besides n. Medianus contains the carpal tunnel of the hand 9 flexor tendons and a. Medianus.

Prevalence indicated ranging from about 1% to 9% among women and about 0.5% to 1% among men. The lowest of these prevalence rates are probably the correct one.

Clinical criteria:
The initial symptoms will be tingling and numbness into the radial 3½ fingers as kompresionen first initially affecting the sensory fibers. There may be radiating pain or, more rarely, burning sensations in the same fingers. Typically, nocturnal awakening with the symptoms described. If the condition has persisted for longer or compression is pronounced can be seen motor outcomes from the involved muscles (mm. Abductor pollicis brevis, opponens pollicis radial part of the flexor pollicis brevis and lumbricalerne for 2nd and 3rd finger) with symptoms form of languor and butter fingers.

Findings: Decreased sensibility sv. t. the radial 3½ fingers from around in the middle of the palm and the fingers on the distal and dorsal sv. t. the distal interphalangeal. There can be seen positive Tinel's test (the bank on flexorretinaklet trigger radiating sensation in the radial 3½ fingers) or Phalen's test (symptoms triggered by maximal flexion of the wrist for 1 minute). In clinical series of KTS patients, these test positive in 60-80% with decreasing sensitivity and specificity of the milder symptoms. For advanced symptoms can be seen tenaratrofi and can be observed reduced force by abduction and / or oppositional of thumb.

Clearing Program and diagnostics
The patient should be referred to neurophysiological examination by clinical suspicion of KTS. This is performed with surface electrodes and involves no major discomfort. In most departments responsible for treatment is a prerequisite for the operation, that there is a nerve conduction study, which is compatible with KTS, but particularly in the practice often operated solely on the clinical picture. It is important to compare the clinical symptoms of the finds from the neurophysiological examination, as there may be both false positive and negative tests. Although there is no indication for surgery, for example. at ease symptoms, this diagnostic study indicated the sake of career guidance. On more pronounced symptoms, and in any event by motor symptoms, patient should be referred for evaluation with the surgeon (neuro - orthopedic + pæd- or hand surgeon) MHP. operation indication.



Epidemiology and risk factors:
The disease is most common among women (3: 1) and in the age group 40-60 years. Family history, body mass index, pregnancy, certain medical disorders (including myxedema, rheumatoid arthritis, diabetes mellitus) and former håndledsfraktur plays a role. Tenosynovitis Thought to be a cause, which is based on clinical experience and is not epidemiologically shown. On the whole, considered conditions resulting in reduction of the space in the carpal tunnel, posing an increased risk. There are shown an increased risk of CFS by job that involves a combination of repetitivitet and power. Repetitivitet alone may constitute a risk. The importance of hand-arm vibration in itself is not entirely clear, because exposure to vibration almost always occur simultaneously with exertion.

Medical, commercial and industrial consultancy
The condition is covered by occupational list and recognized when there have been strenuous and repetitive work, hand-arm vibration, or direct pressure against the hollow of her hand. When exposed to hand-arm vibration require the same overall exposure by recognizing Mb. Raynaud. It also acknowledges KTS caused by tenosynovitis, if this meets the requirements for recognition.

Literature
Stevens JC, Sun S, Beard CM, O'Fallon WM, Kurland LT. Carpal tunnel syndrome in Rochester, Minnesota, in 1961 two 1980. Neurology 1988; 38: 134-138.

Atroshi, In., Gummesson, C., Johnsson, R .; Ornstein, E., Ranstam, J., Rosen, I..Prevalence of carpal tunnel syndrome in a general population. JAMA 1999; 282: 153-158.

Ergonomic strain

Frost P, Andersen JH, Nielsen VK. Occurrence of carpal tunnel syndrome among Slaughterhouse workers. Scand J Work Environ Health 1998.24: 285-292.

Thomsen JF, Hansson G Oh, Mikkelsen S, Lauritzen ML, Carpal tunnel syndrome in repetitive work: a follow-up study. Am J Ind With 2002; 42: 344-353.

Palmer K, Harris EC, Coggon D. Carpal tunnel syndrome och dess förhållande occupation: a Systematic literature review. Occupational Medicine 2007. 57 (1): 57-66.