PRESENTASI KASUS

Carpal Tunnel Syndrome

Presented By :
IHSANUL PIKRI
Plan
Definition
Epidemiology
Etiology
Clinical Features
Physical examination
Diagnostic
Differential Diagnostics
Treatment
Definition

Carpal tunnel syndrome, the

most common focal peripheral
neuropathy, results from
compression of the median
nerve at the wrist.
 Epidemiology
• Race
– Whites at highest risk of developing CTS.
– Very rare in some racial groups (eg, nonwhite
South Africans)[2]
• Sex
– Female-to-male ratio is 3-10:1 [2]
• Age
– The peak age range for development of CTS is 45-
60 years. Only 10% of patients with CTS are
younger than 31 years [2]
 Pathophysiology[2]
The tendons of the hands are wrapped with a lining that
produce a synovium fluid which lubricates the tendons

With repetitive movement of the hand, the lubrication

system may malfunction

This reduction in lubrication results in inflammation and

swelling of the tendon area

Abnormally high carpal tunnel pressures exist in patients

with CTS.

This pressure causes obstruction to venous outflow, back

pressure, edema formation, and ultimately, ischemia in
the nerve.
Clinical Features

Pain
Numbness
Tingling (menusuk)
Symptoms are usually worse at night and
can awaken patients from sleep.
To relieve the symptoms, patients often
“flick” their wrist as if shaking down a
thermometer (flick sign).
Clinical Features

Pain and paresthesias may radiate to the

forearm, elbow, and shoulder.
Decreased grip strength may result in loss
of dexterity, and thenar muscle atrophy
may develop if the syndrome is severe.
Diagnosis banding dari CTS
antara lain :
1. Cervical radiculopathy. Biasanya keluhannya berkurang bila leher diistirahatkan
dan bertambah hila leher bergerak. Distribusi gangguan sensorik sesuai
dermatomnya.
2. Thoracic outlet syndrome. Dijumpai atrofi otot-otot tangan lainnya selain otot-otot
thenar. Gangguan sensorik dijumpai pada sisi ulnaris dari tangan dan lengan bawah.
3. Pronator teres syndrome. Keluhannya lebih menonjol pada rasa nyeri di
telapak
tangan daripada CTS karena cabang nervus medianus ke kulit telapak tangan
tidak melalui terowongan karpal.
4. de Quervain's syndrome. Tenosinovitis dari tendon muskulus abductor pollicis
longus dan ekstensor pollicis brevis, biasanya akibat gerakantangan yang
repetitif. Gejalanya adalah rasa nyeri dan nyeri tekan padapergelangan tangan di
dekat ibu jari. KHS normal. Finkelstein's test :palpasi otot abduktor ibu jari pada
saat abduksi pasif ibu jari, positif bila nyeri bertambah.
Phalen’s maneuver
Penderita diminta
melakukan fleksi tangan
secara maksimal. Bila
dalam
waktu 60 detik timbul
gejala seperti CTS, tes ini
menyokong diagnosa.
Beberapa
penulis berpendapat bahwa
tes ini sangat sensitif untuk
menegakkan diagnosa CTS.
Tinel’s sign
Tes ini mendukung
diagnosa bila timbul
parestesia atau nyeri
pada daerah
distribusi nervus
medianus jika
dilakukan perkusi pada
terowongan karpal
dengan
posisi tangan sedikit
dorsofleksi.
Flick's Sign

Penderita diminta mengibas-ibaskan

tangan atau menggerak gerakkan jari-
jarinya.Bila keluhan berkurang atau
menghilang Akan Menyokong Diagnosa
CTS.
Compression test

Nervus medianus ditekan di terowongan

karpal dengan menggunakan ibu jari. Bila
dalam waktu kurang dari 120 detik timbul
gejala seperti CTS, tes ini menyokong
diagnose.
Differential Diagnostics

Tendonitis
Tenosynovitis
Diabetic neuropathy
Kienbock's disease
Compression of the Median nerve at the
elbow
ULTRASOUND THERAPY

•May be beneficial in the

long term management
•More studies are needed
to confirm it’s usefulness
1. US dgn frequency 1 MHz, intensity of 1.0
W/cm selama 15 minute.
 EXERCISES
THERAPY
• Physical Therapy
• Given CTS is associated with low
aerobic fitness and increased
BMI, it is inherent to provide
the patient with an aerobic
• fitness program.
Stationary biking, cycling, or any
other exercise that puts strain
on the wrists probably should
• be avoided.
It may be possible to enlarge
the carpal tunnel by specific
stretching techniques. Such an
exercise program may provide a
new noninvasive treatment for
CTS in the future.[2]
Hand exercise seperti
tendon, dan nerve
gliding pada jurnal
lanjut….
−Neurodynamic Techniques
1. Functional massage pada area m. upper trapezius selama 3 menit.
2. 3 gerakan wrist mobilization (Shacklock, 2005) dengan durasi 15 detik dan
istirahat 1o detik.
3. Neurodynamic mobilization consisted of 3 series of 60 repetitions of glide and
tension mobilizations separated by interseries intervals of 15 seconds.
SOURCES :

American family physician july 15 2003

www.aafp.org/afp
Essantials of musculoskeletal care
C.Cabrol anatmie tome 1
Lanjut pembahasan Status Klinis
Pasien