A 40-yrs-old woman complains of pain in her right wrist

Discussion in 'MRCS Forum' started by Lona., Dec 14, 2007.

  1. Lona.

    Lona. Guest

    A 40-yrs-old woman complains of pain in her right wrist. There are also paresthesias in her hand. With her diagnosis, which statement is correct?
    a- It’s rarely secondary to trauma
    b- It may be associated with pregnancy
    c- It most often causes dysesthesia during waking hours
    d- It is often associated with vascular compromise
    e- Surgical treatment involves release of the extensor retinaculum
  2. Lona.

    Lona. Guest

    Answer: b. (Schwartz, 7/e, pp 2063-2070) Signs and symptoms of carpal tunnel syndrome are related to the distribution of the median nerve. This nerve, which passes through the carpal tunnel in the wrist with the finger flexor tendons, may suffer compression from fibrous scarring or malalignment following a fracture of the wrist. Nerve compression may also occur in patients with rheumatoid arthritis who develop flexor tenosynovitis. In women, the syndrome frequently first appears during pregnancy and recurs during the premenstrual phase of subsequent menstrual cycles. In these cases, symptoms are presumably the result of the effects of fluid retention and pressure on the median nerve owing to tissue swelling. In many instances, symptoms are limited to nocturnal pain and paresthesias. If conservative treatment of carpal tunnel syndrome is unsuccessful, surgical treatment may be required. Open and Endoscopic techniques have been employed, both of which release adhesions of the median nerve and divide the transverse carpal ligament. The extensor retinaculum is located on the dorsal aspect of the wrist and contains the six compartments of extensor tendons.

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