Carpal Tunnel Syndrome

Auddrey S
Anastasia F
Definisi

Carpal tunnel syndrome,

neuropati perifer fokal yang
paling umum, hasil dari
kompresi saraf median pada
pergelangan tangan.
epidemiology
Wanita : Pria = 3:1
>> 40-60 tahun
Manifestasi Klinis
Gejala tahap awal  gangguan sensorik
saja.
– Parestesia
– Hilangnya sensasi atau rasa seperti terkena
aliran listrik pada jari dan setengah sisi radial
jari walupun kadang-kadang dirasakan
mengenai seluruh jari-jari.
– Keluhan parestesi biasanya lebih menonjol di
malam hari.
Manifestasi klinis

Nyeri berkurang ketika pasien

memijat,memposisikan tangan lebih tinggi,
mengistirahatkan tangannya.
Kadang-kadang rasa nyeri menjalar ke
lengan atas dan leher, sedangkan
parestesia umumnya terbatas di daerah
distal pergelangan tangan
Manifestasi Klinis

Pembengkakan dan kekakuan pada jari-

jari, tangan, dan pergelangan tangan
terutama di pagi hari berkurang ketika
tangan digerakan
Pada penderita carpal tunnel syndrome
pada tahap lanjut dapat dijumpai atrofi otot-
otot thenar dan otot-otot lainnya yang di
inervasi oleh saraf medianus.
Atrophy
Physical examination

Flick’s sign
Tennar Wasting
Wirst Extention test
Phalen’s maneuver
Tinel’s sign
Tourniquet Test
Phalen’s maneuver
Tinel’s sign
Diagnostic

Anamnesis
PF
Nerve Conduction Study
Diagnosis Banding

Tendonitis
Tenosynovitis
Diabetic neuropathy
Kienbock's disease
Compression of the Median nerve at the
elbow
Treatment
CONSERVATIVE TREATMENTS
– GENERAL MEASURES
– WRIST SPLINTS
– ORAL MEDICATIONS
– LOCAL INJECTION
– ULTRASOUND THERAPY
– Predicting the Outcome of Conservative
Treatment
SURGERY
GENERAL MEASURES

Avoid repetitive wrist and hand motions that

may exacerbate symptoms or make
symptom relief difficult to achieve.
Not use vibratory tools
Ergonomic measures to relieve symptoms
depending on the motion that needs to be
minimized
WRIST SPLINTS
Probably most
effective when it is
applied within three
months of the onset of
symptoms
Optimal splinting
regimen ?
WRIST SPLINTS
ORAL MEDICATIONS

Diuretics
Nonsteroidal anti-inflammatory drugs
(NSAIDs)
pyridoxine (vitamin B6)
Orally administered corticosteroids
– Prednisolone
– 20 mg per day for two weeks
– followed by 10 mg per day for two weeks
LOCAL INJECTION

A mixture of 10 to 20 mg of lidocaine
(Xylocaine) without epinephrine and 20 to
40 mg of methylprednisolone acetate
(Depo-Medrol) or similar corticosteroid
preparation is injected with a 25-gauge
needle at the distal wrist crease (or 1 cm
proximal to it).
LOCAL INJECTION
LOCAL INJECTION
LOCAL INJECTION

Splinting is generally recommended after

local corticosteroid injection.
If the first injection is successful, a repeat
injection can be considered after a few
months
Surgery should be considered if a patient
needs more than two injections
ULTRASOUND THERAPY

•May be beneficial in the

long term management
•More studies are needed
to confirm it’s usefulness
SURGERY
Should be considered in patients with
symptoms that do not respond to
conservative measures and in patients with
severe nerve entrapment as evidenced by
nerve conduction studies,thenar atrophy, or
motor weakness.
It is important to note that surgery may be
effective even if a patient has normal nerve
conduction studies
SURGERY
Complications of surgery
Injury to the palmar cutaneous or recurrent motor
branch of the median nerve
Hypertrophic scarring
laceration of the superficial palmar arch
tendon adhesion
Postoperative infection
Hematoma
arterial injury
stiffness
SURGERY
Daftar Pustaka

www.aafp.org/afp