101. Management Of Carpal Tunnel Syndrome - July 15, 2003 - American Family Physician Carpal tunnel syndrome affects approximately 3 percent of adults in the and rehabilitation in the treatment of carpal and cubital tunnel syndromes. http://www.aafp.org/afp/20030715/265.html

Advanced Search AAFP Home Page Journals Vol. 68/No. 2 (July 15, 2003) COVER ARTICLE PRACTICAL THERAPEUTICS Management of Carpal Tunnel Syndrome ANTHONY J. VIERA, LCDR, MC, USNR, Naval Hospital, Jacksonville, Florida A patient information handout on carpal tunnel syndrome, written by the author of this article, is provided on page 279. A PDF version of this document is available. Download PDF now (8 pages /151 KB). More information on using PDF files. C arpal tunnel syndrome, the most common focal peripheral neuropathy, results from compression of the median nerve at the wrist. The syndrome affects an estimated 3 percent of adult Americans and is approximately three times more common in women than in men. High prevalence rates have been reported in persons who perform certain repetitive wrist motions, but the significance of this relationship continues to be challenged. Although 30 percent of frequent computer users complain of hand paresthesias, only 10 percent meet clinical criteria for carpal tunnel syndrome, and nerve conduction studies are abnormal in only 3.5 percent of these persons. See page 204 for definitions of strength-of-evidence levels.

102. Hospital Practice: Carpal Tunnel Syndrome In the case of carpal tunnel syndrome (CTS), however, this definition is often gentle percussion) over the left cubital tunnel just distal to the elbow. http://www.hosppract.com/issues/1999/03/ceatch.htm

Carpal Tunnel Syndrome: Is It Work-Related? STEVEN G. ATCHESON Arthritis Specialists of Northern Nevada The reported incidence of work-related carpal tunnel syndrome has skyrocketed; however, many cases have an underlying systemic cause. A methodical investigationincluding appropriate imaging studies and laboratory testingcan differentiate symptoms that are primarily occupational from those with associated medical illness or obesity. Dr. Atcheson is a board-certified rheumatologist practicing in Reno, Nev. Case Presentation A 59-year-old woman was referred for evaluation of hand numbness that had persisted after carpal tunnel surgery. Her problems had begun nine years earlier with onset of pain at the base of each thumb. Regular use of ibuprofen allowed her to continue working. After three years, nocturnal numbness and tingling developed in both hands. These symptoms were relieved by activity, however. The patient, a professional card dealer for more than 30 years, had assumed that her thumb pain was work-related. When it developed nine years earlier, she had consulted an orthopedist, who diagnosed osteoarthritis of the basilar thumb joints and CTS. He advised her to file a workers' compensation claim, which was accepted. She subsequently underwent bilateral carpal tunnel releases, arthroplasties of the first carpometacarpal joints, and trapeziectomies. At surgery, slight flattening of the right median nerve was noted. The left median nerve appeared to be normal. After returning to her regular job, she had experienced only minimal discomfort in her thumbs while dealing cards, but the nocturnal hand numbness continued. Five years after surgery she applied for reopening of her compensation claim because of paresthesias on the palmar sides of the third, fourth, and fifth digits while at rest. Shaking or other hand activity relieved the discomfort. Her workers' compensation physician warned that she faced permanent nerve damage if she continued to work as a card dealer and advised her to change occupations. Reluctant to do so, she decided to seek a second opinion.

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