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Old 07-02-2012
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Rheumatology/Orthopedics Carpal Tunnel Syndrome; Next Best Step

What is next step in clinically suspected Carpal Tunnel Syndrome?

-Wrist x ray to rule out other possible lesions
-Splinting
-NSAIDs
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Old 07-02-2012
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if the history is clear and there is a high suspicion, go straight to treatment

order of treatment depends on severity/ past history of disease etc.

but in a newly diagnosed patient 1st is splinting


steroids are tried if the conservative medication fails

Nsaids come some where in between (can be tried category)


http://emedicine.medscape.com/articl...reatment#a1137
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Old 07-02-2012
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Quote:
Originally Posted by tyagee View Post
What is next step in clinically suspected Carpal Tunnel Syndrome?

-Wrist x ray to rule out other possible lesions
-Splinting
-NSAIDs
Splinting

Depends on the HPE

Quote:
Current recommendations generally don't suggest immobilizing braces, but instead activity modification and non-steroidal anti-inflammatory drugs as initial therapy, followed by more aggressive options or specialist referral if symptoms do not improve.[60][61]
Many health professionals suggest that, for best results, one should wear braces at night and, if possible, during the activity primarily causing stress on the wrists.[62][63]
Quote:
No imaging studies are considered routine in the diagnosis of carpal tunnel syndrome (CTS).

Magnetic resonance imaging (MRI) of the carpal tunnel is particularly useful preoperatively if a space-occupying lesion in the carpal tunnel is suggested. Signal abnormality can be detected in the median nerve in some cases of CTS, but how these abnormalities correlate to diagnosis and physiologic severity is not clear. MRI does not rule out the multitude of other differential diagnoses and is time consuming and resource intensive.[10]

Ultrasonography potentially can pick up some space-occupying lesions in the carpal tunnel. Problems differentiating the median nerve from surrounding soft tissue (particularly distally) severely limit its role in diagnosis at present
Quote:
Other conditions may also be misdiagnosed as carpal tunnel syndrome. Thus, if history and physical examination suggest CTS, patients will sometimes be tested electrodiagnostically with nerve conduction studies and electromyography.
When pain is the primary symptom, carpal tunnel syndrome is unlikely to be the source of the symptoms.

Last edited by Novobiocin; 07-02-2012 at 05:47 PM.
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