Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presence of risk factors
- numbness of hand(s)
- nighttime worsening
- numbness in median nerve distribution
- numbness confined to palmar aspect of the first 4 fingers
Outros fatores diagnósticos
- symptoms are intermittent
- onset is gradual
- weakness of hand
- clumsiness
- aching and pain in arm
- weakness of thenar muscles (abductor pollicis brevis, or APB, in particular)
- normal reflexes
- finger stiffness
- cold sensitivity
- atrophy of thenar eminence
Fatores de risco
- age 40-60 years
- high BMI
- female sex
- fractured wrist/carpal bones
- square wrist
- rheumatoid arthritis
- diabetes
- pregnancy
- congenital carpal tunnel stenosis
- occupational exposure
- tobacco smoking
- thyroid disorders
- significant computer use
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- electromyogram (EMG)
Investigações a serem consideradas
- ultrasound of the wrist
- MRI of the wrist
Algoritmo de tratamento
clinical diagnosis of carpal tunnel syndrome (CTS) without electromyogram (EMG) confirmation, or pregnant women
mild or moderate based on EMG findings (nonpregnant)
severe based on EMG findings (nonpregnant)
moderate based on EMG findings + failed splint and corticosteroid injection(s)
refractory to surgery
Colaboradores
Autores
Nigel Ashworth, MBChB, MSc, FRCP(Can)
Professor
Division of Physical Medicine & Rehabilitation
Faculty of Medicine & Dentistry
University of Alberta
Edmonton
Canada
Declarações
NA is an author of a number of references cited in this topic.
Revisores
Ines C. Lin , MD, MSEd
Associate Professor of Surgery
Division of Plastic Surgery, Department of Surgery, and Department of Orthopaedic Surgery
Perelman School of Medicine at the University of Pennsylvania
Philadelphia
PA
Declarações
ICL declares that she has no competing interests.
Peter C. Amadio, MD
Dean for Research Academic Affairs
Lloyd A. and Barbara A. Amundson Professor of Orthopedic Surgery
Professor of Biomedical Engineering
Mayo Clinic
Rochester
MN
Declarações
PCA declares that he has no competing interests.
Shawn Marshall, MD, MSc
Associate Professor
University of Ottawa
Ottawa
Ontario
Canada
Declarações
SM declares that he has been primary author and co-author of Cochrane systematic reviews of nonsurgical interventions for treatment of carpal tunnel syndrome.
Tim J. Doherty, MD, PhD
Associate Professor
The University of Western Ontario
London
Ontario
Canada
Declarações
TJD declares that he has no competing interests.
Michael Plant, MD, FRCP
Consultant Rheumatologist
The James Cook University Hospital
South Tees Hospitals NHS Foundation Trust
Middlesbrough
UK
Declarações
MP declares that he has no competing interests.
Referências
Principais artigos
Cartwright MS, Hobson-Webb LD, Boon AJ, et al; American Association of Neuromuscular and Electrodiagnostic Medicine. Evidence-based guideline: neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome. Muscle Nerve. 2012 Aug;46(2):287-93. Resumo
Ashworth NL, Bland JDP, Chapman KM, et al. Local corticosteroid injection versus placebo for carpal tunnel syndrome. Cochrane Database Syst Rev. 2023 Feb 1;2(2):CD015148.Texto completo Resumo
Peters S, Page MJ, Coppieters MW, et al. Rehabilitation following carpal tunnel release. Cochrane Database Syst Rev. 2016 Feb 17;(2):CD004158.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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