Carpal Tunnel Syndrome and Ganglion pptx

Diseases of hand

1. BVVS HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL,BAGALKOT. SEMINAR PRESENTATION TOPIC : Carpal Tunnel Syndrome & Ganglion Guided By: Dr.Pradeep.Reddy Sir Presented By: Arjun.M

2. CARPAL TUNNEL SYNDROME Defination : CTS is the most common focal peripheral neuropathy,results from compression of median nerve at the wrist. It can lead to numbness,tingling,weakness,or muscle damage in hand and fingers.

3. ANATOMY Carpus is a word derived from the Greek word “ karpos ” which means “wrist”. The wrist is surrounded by a band of fibrous tissue that normally functions as support for the joint. The tight space between the fibrous band and wrist bone is called carpal tunnel.

4. Cont ,, The median nerve passes through the carpal tunnel to receive sensations from thumb, index,and middle fingers of the hand.

5. CAUSES for CTS Joint dislocations,i.e ., lunate dislocation. Fractures,i.e ., malunited colle’s fracture. Radiocarpal arthritis. Flexor tendon tenosynovitis. Myxoedema and acromegaly. Posture- keeping the wrist bent for longer time. Repetitive wrist movements.

6. CAUSES cont ,, Pregnancy-fluid retention during pregnancy can cause swelling in the tunnel and symptoms of CTS,which often go away after delivery. Rheumatoid arthritis.

7. FEATURES Common in females. Condition is often bilateral. Tingling , numbness, paraesthesia and burning sensation in the lateral three and half fingers supplied by median nerve. Burning sensation gets aggravates at night. Features of low median nerve palsy i.e..thumb deformity ,wasting of thenar muscles,and weakness of muscles. When BP cuff is inflated patient feels the typical pain in the fingers. Phalen’s test (wrist flexion test) is positive.

8. SIGNS AND SYMPTOMS Tingling Numbness in the lateral three and half fingers. Intermittent pain in the distribution of median nerve. Symptoms get aggravated at night.

9. CONT,, MOTOR CHANGES: > Apelike thumb deformity. > Loss of opposition of thumb. > Index and middle finger lag behind when making fist.

10. CONT,, SENSORY CHANGES: > Loss of sensation of lateral 3 ½ digots including the nail bed and distal phalanges on dorsum of hand. VASOMOTOR CHANGES: > Skin area with sensory loss is warmer > dry skin TROPHIC CHANGES: > Nails crack easily > Atropy of pulp of fingers

11. DAIGNOSIS Physical assessment test: Less sensitivity to pain where the median nrve runs to fingers. Thumb weakness. Inability to tell the difference between one and two sharp points on fingertips.

12. Phalen’s test - The patient rest the elbows on the table. - The wrist flexion with fingers pointing down and backs of the hands pressed together. POSITIVE : If symptoms devolops within a minute , CTS is indicated.

13. Tinel’s sign test: In the Tinel’s sign test, the doctor taps over the median nerve to produce a tingling or mild shock sensation.

14. Durkan test: The doctor presses over the carpal tunnel for 30 seconds to produce tingling or shock in median nerve. Hand elevation test: The patient raises his or her hand overhead for 2 minutes to produce symptoms of CTS. Nerve conduction studies and, Electromyography.

15. TREATMENT Medical line of treatment: - Oral cortisones usually MEDROL Dosepacks . - Oral cortisones and local injections are used to relieve pressure(inflammation) on the median nerve and provide immediate and temporary relief to persons with mild or intermittent symptoms.

16. Local cortisone injections: - Corticosteroids and lidocaine(local anesthetic ) can be injected - directly into the wrist.

17. Conservative line of treatment: > Wrist brace > Avoid inadequate posture and repitative wrist movement. > Keyboard and mouse support.

18. Cont ,, Median nerve gliding exercise. Carpal Tunnel Stretch.

19. Surgical line of treatment: OCPR –Open Carpal Tunnel Release

20. ECTR: Endoscopic Carpal Tunnel Release

21. HOMOEOPATHIC REMEDIES CAUSTICUM - Weakness in hands , numbness, and pain in the fingers. - It is more indicated in when CTS has increased to a level where is an excessive weakness in hands. - Muscles of hand have atrophied. - Causticum is indicated in case of CTS if palmer side of hand has flat appearance. RUTA -CTS from overuse of wrist. -Indicated in tendonitis or wrist fractures.

22. HYPERICUM: - Damaging to the median nerve triggers the CTS. - Indicated in nerve injury. - Indicated in numbness , tingling and burning pain in fingers and hand. ARNICA: - This medicine is useful in managing cases of CTS from injury or overuse of wrist. -It is suitable when there is pain in hands. - Also indicated in tingling in hands and arms.

23. RHUS TOX: - Rhus tox is very effective when CTS is caused by overuse of wrist . - And also CTS is caused by wrist joint inflammation (arthritis). - This medicine is indicated in pain and tenderness in the wrist. - Any pressure exerted on the wrist is unbearable. - Numbness in fingers especially index and middle fingers in morning. BELLIS PERENNIS: - CTS from repetitive strain injury. - Indicated when contracted feeling in the wrist. - Feels as if there is an elastic band around the wrist contracting it.

24. GANGLION CYST

25. INTRODUCTION Ganglion - Ganglion is a localized,tense cystic swelling in connection with the joint capsule or tendon sheaths. It contains clear gelatinous fluid. Also known as Bible cyst. Common in women,and 70% occur in people between the ages of 20-40yrs. Rarely, ganglion cyst can occur in children younger than 10 yrs.

26. AETIOLOGY The cause of ganglion cyst is unknown. Synovial herniation. Mucus cyst formation. Myxoid degeneration of fibrous tisse of capsule,ligaments and retinaculae of the joint. According to some,ganglion arises from small bursa within the substance of the joint capsule or the fibrous tendon sheath. Ganglion sometimes initiated or excited by injury.

27. SITES OF GANGLION CYST Dorsum of the wrist. Front of the wrist. The dorsum of foot. Palmer aspect of the hand. The flexor aspects of fingers.

28. CLINICAL FEATURES Common in females. Size show variation with time. Intermittantly painful,following repetative trauma. Pain ,worse on joint motion. When cyst is connected to a tendon,weakness in the affected finger.

29. ON EXAMINATION: INSPECTION - Swelling on the dorsum of wrist( somrtimes on volar aspects) . - Pea size (occasionally larger). PALPATION - Very firm/ bony hard. - Wrist ROM is normal. Mobility: - Mobility is not much, though it can be moved with great difficulty sideways. - It is immobile along the axis of the tendon.

30. INVESTIGATIONS Ultrasonography : - To determine whether the bump is fluid –filled or if it is solid. -to detect whether an artery or blood vessels causing the lump. MRI -To see the wrist. Refer to the hand surgeon .

31. MANAGEMENT > CONSERVATIVE - Observation. - Closed rupture. - Cyst puncture. - Aspiration > SURGICAL - Excision.

32. HOMOEOPATHIC REMEDIES RUTA > The cyst may be present on the wrist,hand and fingers. > The ganglion tend to interfere with joint movement of wrist. > Numbness in the hands may be present along with pain in wrist joint. > Numbness and tingling in the hands after the exercise most of the time. > History of injury to tendon or joint. RHUS TOX > Rhus tox is very suitable for managing pain in wrist in cases of ganglion cyst. > The pain tends to get worse during rest,and also worsen by cold,and in some cases bending the wrist also tend to worsen the pain. > Motion relieves the pain in wrist in most cases rhus tox is indicated. > Pain of drawing nature in palm of hand along with numbness and burning sensation in hand.

33. RHODODENDRON > Rhododendron is another medicine for managing wrist pain in ganglion cyst. > Drawing and tearing pain in wrist. > The pain may get worse in the evening time. > Rest also worsen the pain. > Heated sensation in the hands may be present occasionally. SILICEA > Ganglion cyst on left side of the wrist. > The cyst is located on extensor surface of wrist. > Tearing and stitching type of pain and numbness in hand. CALCAREA CARB- ganglion cyst on the right side of wrist. ARNICA- Ganglion cyst with history of wrist injury.