Peripheral neuropathy.Turki M. Alanazi

Objectives •Enumerate sites of peripheral nerve

compression and discuss features of carpal tunnel syndrome.

Sites of peripheral nerve compression

Carpal Tunnel Syndrome.•Most common entrapment neuropathy.• Female to Male ration = 4:1•Compression of the Median Nerve at the wrist

by the Transverse Carpal Ligament.

Carpal Tunnel Syndrome.• Idiopathic cause but it is associated with ..▫Occupation.▫Hypothyroidism▫Diabetes mellitus▫Pregnancy (third trimester)▫Obesity. ▫Rheumatoid disease▫ Acromegaly▫amyloid▫Renal dialysis patients.

Clinical Features • Pain or paresthesia (numbness and tingling) in the first

three digits and the radial half of the fourth digit ( 3.5) patient awakened at night, the pain is relieved by shaking or

rubbing. •Sensory loss in median nerve distribution i.e. radial 3.5

digits.•Weakness and wasting of Thenar muscles ( late

feature).• Positive Tinel’s sign. • Positive Phalen’s sign.

Tinel’s sign

Phalen’s maneuver/sign

CTS Treatment

•Most cases of CTS can be adequately treated with conservative (i.e. non-surgical) management.▫Rest

avoid repetitive wrist and hand motion, wrist splints when repetitive wrist motion required.

▫Wrest splint night time splinting to keep wrist in neutral position.

▫Medications NSAIDs, local corticosteroids injection, oral

corticosteroids

Surgical treatment of CTS• Indications for surgery:

Numbness and tingling ± sensory loss. Weakness ± muscle atrophy. Unresponsive to conservative measures.

Open Endoscopic

Summary • Sites of peripheral neuropathies

• Pain or paresthesia (numbness and tingling) in the first three digits and the radial half of the fourth digit ( 3.5).

• Sensory loss in median nerve distribution i.e. radial 3.5 digits.

•Weakness and wasting of Thenar muscles ( late feature).

• Positive Tinel’s sign. • Positive Phalen’s sign.

Clinical features of CTS

References