Hand CASE 41

CASE                               41                               

The patient is a 29-year-old, right-hand-dominant G1 P0 woman, currently 7 months pregnant, who presents with edematous hands and numbness in her thumbs bilaterally. She reports that her symptoms are worst at night and wake her up from sleep. The patient states that she did not have similar symptoms prior to pregnancy. On examination, she has a positive Durkan test but no weakness or thenar atrophy. She is diagnosed with carpal tunnel syndrome of pregnancy.

What is the Durkan test and what is the approximate sensitivity of the test?

1. Wrist flexion test, 25%

2. Wrist flexion test, 50%

3. Wrist flexion test, 90%

4. Direct compression test, 50%

5. Direct compression test, 90%

Discussion

The correct answer is (E). There are many clinical maneuvers which can be used to examine a patient for carpal tunnel syndrome. The Durkan test places direct compression over the median nerve at the carpal tunnel for approximately 30 seconds and is positive with the onset of paresthesias or pain in the median nerve distribution. The approximate sensitivity and specificity are 90%. The wrist flexion, or Phalen test, is performed by asking the patient to flex his/her wrists to 90 degrees

—thereby increasing the pressure within the carpal tunnel—and examining for median nerve symptoms. The sensitivity and specificity are generally thought to be less than that for the Durkan test.

What is the approximate incidence of pregnancy-induced symptoms of carpal tunnel syndrome?

1. 1%

2. 10%

3. 25%

4. 75%

5. 90%

 

Discussion

The correct answer is (C). Carpal tunnel syndrome during pregnancy is common and is believed to occur in approximately 25% of pregnant women. The etiology appears to be related to whole body edema during the later phases of pregnancy, which in turn causes swelling within the carpal tunnel. In women with prior, asymptomatic compression or a diathesis for compression, symptoms can manifest during pregnancy.

Which of the following is true about carpal tunnel syndrome during pregnancy?

1. Pregnancy is a risk factor for developing carpal tunnel syndrome

2. Surgical intervention for carpal tunnel syndrome during pregnancy is dangerous and should be avoided because it poses significant risks to the mother and fetus

3. Pregnant women frequently experience nocturnal symptoms which can often be treated conservatively

4. A and B

5. A and C

Discussion

The correct answer is (E). It is true that carpal tunnel syndrome is more common within pregnant women, and that most women with this problem can be treated conservatively with the expectation that symptoms will improve and/or resolve following delivery. If surgical intervention is required, it can be safely performed under the direction of an experienced anesthesiologist.

 

Objectives: Did you learn...?

 

Properly perform the Durkan’s Test?

 

 

Describe the sensitivity and specificity of Durkan’s test? Treat pregnancy-induced carpal tunnel syndrome?

 

Describe the incidence of pregnancy-induced carpal tunnel syndrome?