C. Carpal tunnel syndrome (CTS) occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist.
SUGGESTIVE. OF... C.. COMPRESSION. OR INFLAMMATION. OF ......MEDIAN. NERVE...
C. Median nerve
Answer is C
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RHEUMATOID ARTHRITIS RA is a type of inflammatory arthritis. Other examples include seronegative spondyarthritides, reactive arthritis, lyme arthritis, crystal arthritis and postviral arthritis. Features of inflammatory arthritis : ●Pain and stiffness worse in the morning and after rest. ●Early morning pain and stiffness may last several hours (in OA, duration is much shorter). ●Inflammatory markers (ESR, CRP)usually raised. ●Often accompanied by normochromic, normocytic anaemia. This is a chronic symmetrical arthritis. When we say it is symmetrical, we don’t necessarily mean a mirror image, just that the same joints are affected on both sides of the body. it is also important to remember that RA is a systemic condition, with many extra-articular manifestations. This is a chronic symmetrical arthritis. When we say it is symmetrical, we don’t necessarily mean a mirror image, just that the same joints are affected on both sides of the body. it is also important to remember that RA is a systemic condition, with many extra-articular manifestations. Typically it affects the peripheral joints, and there is inflammation of the joint (synovitis). Deformity is common and the course is extremely variable. Epidemiology and Aetiology : ●Affects 0.5-3% of the population worldwide. ●Can present at any age (from childhood to old age), but the peak incidence is between 30-50 years. ●women affected more than men (M:F – 1:2). ■before the menopause, risk is 3x higher for women . ■after the menopause it is equal. ■suggests sex hormones involved in some way. ■the contraceptive pill can delay the onset, but does not reduce the risk. ●Genetic factors are involved. Certain HLA variants are implicated, especially in severe forms of the disease:. ●HLA-DR4 – occurs in 50-75% of patients, and is associated with a particularly poor prognosis. ●HLA-DR1 is another variant associated with RA, and poor prognosis. ●Environmental factors: ¤Smoking ¤Stress ¤Infection Clinical features : Most commonly, the condition will present as progressive over weeks to months. These patients have the worse prognosis. But in some cases it can come on in days, or even overnight. Also, it is almost always a polyarthritis, but some cases do present as monoarthritis, most commonly of the knee or shoulder, or with carpal tunnel syndrome. ●symmetrical swollen distal joints. ●Often warm and tender joints. ●sometimes presents as a sudden onset of widespread arthritis, but this is rare. ●Typically the joint of the hand (MCP, DIP and PIP’s)and the distal metatarsals of the foot. ●Sometimes it affects the wrists, elbows, shoulders, knees and ankles. ●Hips are very rarely affected. ●Limitation of movement. ●Muscle wasting. ●Pain and stiffness – worse in the morning, may improve with activity. It is often described as an ache type pain. ●Disturbed sleep. ●Nodules – in the early and mild stages of the disease, there are relatively few inflammatory cells in the joints. As the disease progresses, these increase in number and there may be nodular masses of inflammatory cells within the joint. Rheumatoid nodules occur when these inflammatory cells form similar inflammatory structures outside of the joint capsules. The nodules are usually pink/red and have a rubbery texture. They are painless. You should always check the elbows in a hand exam, looking for rheumatoid nodules!. ●Osteoporosis – often occurs in the bones immediately around the affected joints, particularly in the fingers. This may be the first sign of RA. ●Secondary Osteoarthritis. ●Deformity – as the joint capsule is destroyed, and the articular surface damaged, deformity occurs. Specific examples include ●Hands ¤Swan necking – the fingers become hyperextended at the PIP, and flexed at the DIP. ¤Z-thumb. ¤Subluxation of the MCP –not that this is not swelling!. ¤Muscle wasting – “guttering” – ‘gutters’ seen between the extensor tendons on the back of the hand. ●Why do the muscles waste so quickly in joint disease? – In a normal individual, if you don’t use a muscle, it will waste at a rate of about 1% of its mass/day. However, in joint disease, the rate of wasting in much greater. This is because in joint disease, there is inhibition of nerve afferents, for nerves that innervate the muscles around a joint. This alters the muscle tone/reflex feedback loop, leading to decreased innervation of the muscle, and as a result, wasting occurs very quickly. ●Inflamed flexor tendon sheaths – these serious impair function. ●Carpal tunnel syndrome is common. ●Ulnar deviation – the fingers point towards the ulnar side. ●Fixed flexion deformity – aka buttonhole or boutonniere deformity. ●Shoulders – Shoulders are commonly affected, and at first it may mimic rotator cuff tendonitis. Later, the joint becomes stiffened. Rotator cuff tears can occur late on. ●Elbows – less commonly affected. Flexion may be lost, which makes eating very difficult. ●Knees – massive synovitis and effusion. These respond well to steroid injection and aspiration. A persistent effusion may increase the risk of cyst formation, and these can rupture. Varus or valgus deformity can occur, and there may be joint space narrowing and secondary OA.Knee replacement can restore much of the function, and relieve pain. ●Cervical spine – pain in the neck is more commonly muscular, but you can get joint disease itself in the cervical spine. There can be bone destruction, which poses a risk to the spinal cord.Be wary loss of sphincter control, or unexplained weakness in late RA – could be due to cord compression!. ●Feet – often the first signs of the disease may only be in the feet. The patient may describe an uncomfortable sensation that feels like walking on marbles. This is due to subluxation of the heads of the metatarsals in the feet. Presentations : ■Palindromic – monoarticular attacks, last 24-48 hours. 50% of cases will progress to other types of RA. ■Transient – lasts <12 months, then permanently remits. Usually seronegative. No lasting damage. ■Remitting – may be active for several years at a time, before remitting. Lasting damage is minimal. ■Chronic, persistent – the most common form. May be seronegative or seropositive. Follows a relapsing remitting course over many years. Seropositive patients have worse joint disease and higher risk of long-term disability. ■Rapidly progressive – rapid progression occurs over several years. Severe joint damage, disability and high rate of complications. Normal initial investigations : ■Blood count: ●Anaemia. ●ESR/CRP raised due to inflammation. Monitoring levels of these can be used to assess treatment . ■Serology – check for rheumatoid factor – only present in 70% of cases. ¤ANA’s – anti-nuclear antibodies – these are also regularly tested for, and show up in 30% of cases. ¤Anti-CCP – testing for this is becoming more common. ■X-ray – useful to get a baseline reading at the start of the disease. Normally only soft tissue swellings initially. Later there may be:¤Boney erosions. ¤Osteopenia (lower than normal bone density). ■Joint aspiration – in the presence of effusion. Aspirate will appear cloudy due to the presence of white cells. If the joint is suddenly painful, always aspirate to check for septic arthritis, as this can rapidly destroy joints. ■MRI – very rarely used, but can show early bone erosions. Also used in widespread disease to assess the extent of the joint damage.Dr. Girish Dahake11 Likes9 Answers
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Patient 60/F, was given IV Diclo inj. for fever by some GP. Came with coplain of swelling, redness burning sensation over 1 2 n 3rd digits. Peripheral Cyanosis present. Tenderness present. Temp slightly raised. Tc N, crp 62. Kindly suggest further rx inx planDr. Lukman Sheth2 Likes8 Answers
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HOMOEOPATHIC REMEDIES FOR CARPEL TUNNEL SYNDROME ￼Carpal tunnel syndrome is a hand and arm condition that causes numbness, tingling and other symptoms. Carpal tunnel syndrome is caused by a pinched nerve in your wrist. A number of factors can contribute to carpal tunnel syndrome, including the anatomy of your wrist, certain underlying health problems and possibly patterns of hand use. Bound by bones and ligaments, the carpal tunnel is a narrow passageway located on the palm side of your wrist. This tunnel protects a main nerve to your hand and the nine tendons that bend your fingers. Compression of the nerve produces the numbness, tingling and, eventually, hand weakness that characterize carpal tunnel syndrome. Fortunately, for most people who develop carpal tunnel syndrome, proper treatment usually can relieve the tingling and numbness and restore wrist and hand function. Causes-Carpal tunnel syndrome occurs as a result of compression of the median nerve. The median nerve runs from your forearm through a passageway in your wrist (carpal tunnel) to your hand. It provides sensation to the palm side of your thumb and fingers, with the exception of your little finger. It also provides nerve signals to move the muscles around the base of your thumb (motor function). ￼ In general, anything that crowds, irritates or compresses the median nerve in the carpal tunnel space can lead to carpal tunnel syndrome. For example, a wrist fracture can narrow the carpal tunnel and irritate the nerve, as can the swelling and inflammation resulting from rheumatoid arthritis. In many cases, no single cause can be identified. It may be that a combination of risk factors contributes to the development of the condition. Symptoms-Carpal tunnel syndrome usually starts gradually with numbness or tingling in your thumb, index and middle fingers that comes and goes. This may be associated with discomfort in your wrist and hand. Common carpal tunnel syndrome symptoms include: Tingling or numbness. You may experience tingling and numbness in your fingers or hand, especially your thumb and index, middle or ring fingers, but not your little finger. This sensation often occurs while holding a steering wheel, phone or newspaper or, commonly, waking you from sleeping. The sensation may extend from your wrist up your arm. Many people "shake out" their hands to try to relieve their symptoms. As the disorder progresses, the numb feeling may become constant. Weakness. You may experience weakness in your hand and a tendency to drop objects. This may be due to the numbness in your hand or weakness of the thumb's pinching muscles, which are controlled by the median nerve. Risk factors--A number of factors have been associated with carpal tunnel syndrome. Although by themselves they don't cause carpal tunnel syndrome, they may increase your chances of developing or aggravating median nerve damage. These include: ￼Anatomic factors. A wrist fracture or dislocation that alters the space within the carpal tunnel can create extraneous pressure on the median nerve. People with smaller carpal tunnels may be more likely to have carpal tunnel syndrome. Sex. Carpal tunnel syndrome is generally more common in women. This may be because the carpal tunnel area is relatively smaller than in men, and there may be less room for error. Women who have carpal tunnel syndrome may also have smaller carpal tunnels than women who don't have the condition. Nerve-damaging conditions. Some chronic illnesses, such as diabetes, increase your risk of nerve damage, including damage to your median nerve. Inflammatory conditions. Illnesses that are characterized by inflammation, such as rheumatoid arthritis, can affect the tendons in your wrist, exerting pressure on your median nerve. Alterations in the balance of body fluids. Fluid retention, common during pregnancy or menopause, may increase the pressure within your carpal tunnel, irritating the median nerve. Carpal tunnel syndrome associated with pregnancy generally resolves on its own after pregnancy. Other medical conditions. Certain conditions, such as menopause, obesity, thyroid disorders and kidney failure, may increase your chances of carpal tunnel syndrome. Workplace factors. It's possible that working with vibrating tools or on an assembly line that requires prolonged or repetitive flexing of the wrist may create harmful pressure on the median nerve or worsen existing nerve damage. However, the scientific evidence is conflicting and these factors haven't been established as direct causes of carpal tunnel syndrome Several studies have evaluated whether there is an association between computer use and carpal tunnel syndrome. However, there has not been enough quality and consistent evidence to support extensive computer use as a risk factor for carpal tunnel syndrome, although it may cause a different form of hand pain. HOMOEOPATHIC REMEDIES Homoeopathic remedies cure this condition permanently without surgery. Some of the important remedies are given below- ARNICA MONTANA 30-Arnica mon. is another remedy for carpel tunnel syndrome due to trauma . It is prescribed when soreness and weakness in the fingers prominent.The person lacks the strength to grip things with his hand. BELLIS PERENNIS 30-Bellis pernnis is another best remedy for carpel tunnel syndrome due injury when the tendons in the carpel tunnel passage get inflamed , thus compressing the median nerve. There is pain , numbness and a tingling sensation arise in the fingers and thumb. Here the pain also arise as a result of repeated strain over the carpel tunnel passage. HYPERICUM PERFORATUM 200-- Hypericum perforatum is an excellentremedy for pain fingers and hands due to carpel tunnel syndrome . Pains are of tingling and burning in character. The numbness and crawling in hands along with pain is another useful symptom for application of this medicine. RUTA GRAVEOLENS 30-Ruta graveolans is an excellent remedy for treating pain in hand and wrist due to carpal tunnel syndrome where the condition arises due to swelling of tendons in the wrist leading to pressure on median nerve .This causes symptoms of pain and numbness in hands and fingers . CAUSTICUM 200--Causticum is another effective medicine for tearing type of pains in hand and fingers with numbness. Causticum can be given in those cases where pain is worse in cold air and better from warm applications on hand. PLUMBUM METALLICUM 200- Plumbum metallicum is used in treatment of pain in hand and finger when along with numbness and tingling there is weakness in the hand , making it impossible for the hand to lift or grasp anything Prevention--There are no proven strategies to prevent carpal tunnel syndrome, but you can minimize stress on your hands and wrists by taking the following precautions: Reduce your force and relax your grip. Most people use more force than needed to perform many manual tasks. If your work involves a cash register, for instance, hit the keys softly. For prolonged handwriting, use a big pen with an oversized, soft grip adapter and free-flowing ink. This way you won't have to grip the pen tightly or press as hard on the paper. Take frequent breaks. Give your hands and wrists a break by gently stretching and bending them periodically. Alternate tasks when possible. If you use equipment that vibrates or that requires you to exert a great amount of force, taking breaks is even more important. Watch your form. Avoid bending your wrist all the way up or down. A relaxed middle position is best. If you use a keyboard, keep it at elbow height or slightly lower. Improve your posture. Incorrect posture can cause your shoulders to roll forward. When your shoulders are in this position, your neck and shoulder muscles are shortened, compressing nerves in your neck. This can affect your wrists, fingers and hands. Keep your hands warm. You're more likely to develop hand pain and stiffness if you work in a cold environment. If you can't control the temperature at work, put on fingerless gloves that keep your hands and wrists warm.Dr. Arpit Gupta5 Likes7 Answers
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What is RSI? RSI (or Repetitive Strain Injury) is a descriptive term for an overuse injury. Occupational Overuse Syndrome (OOS) is another name used to describe RSI. RSI Repeated use of the same movements causes inflammation and damage to the soft tissues (muscles, nerves, tendons and tendon sheaths etc.) In particular, RSI has been attributed to upper limb and forearm pain. Repetitive Strain Injuries (RSI) includes many localised injuries such as trigger finger, golfer’s and tennis elbow and carpal tunnel and also more diffuse pain syndromes (those spread over the body) which may be diagnosed as cervicobrachial pain syndrome or chronic pain syndrome. Common RSI Symptoms Symptoms of RSI or an overuse injury can be any of the following: Burning, aching or shooting pain. Tremors, clumsiness and numbness. Fatigue or lack of strength. Weakness in the hands or forearms. It is often difficult to perform even simple tasks. Difficulty with normal activities like opening doors, chopping vegetables, turning on a tap. Chronically cold hands, particularly the fingertips. Early Signs of RSI The first signs of RSI may be soreness, tingling or discomfort in the neck, arms, wrists, fingers or shoulders. These symptoms may come on when you do something or appear after a repetitive task. Symptoms may disappear when you stop the aggravating activity. It may take only a few hours for the symptoms to settle, or it may take as long as a couple of days. Unfortunately, over time a minor RSI can turn into a nasty chronic injury. Extra stress in your work , or taking fewer breaks can make your symptoms much more severe and long term. What Causes RSI? RSI can be caused by many factors. They include: Repeated arm use for too long Working with equipment that doesn’t fit your body Working too fast Not having enough recovery breaks Holding your muscles in the same position for a long time Lack of training in the safest way to carry out a task Lack of variety in the type of work you do Working in cold conditions What's Injured by RSI? RSI potentially damages your muscles, tendons, nerves and joints through repeated micro-trauma. Muscles & Tendons Whenever muscles or tendons are used, tiny tears can occur in the muscle or tendon tissue. The local area becomes inflamed for a short time as the body attempts to repair the damage. Thickening and scar tissue form over the torn muscle or tendon tissue. At this stage, the area will feel painful. Normally, the body would repair the damage and the pain would go away. However, without enough rest, more activity causes further damage and more inflammation, thickening, scar tissue and pain. This cycle gets progressively worse if sufficient rest is not taken. Under the microscope, changes can be seen in the structure of a muscle or tendon damaged by overuse. Collagen bundles that are normally tight and parallel instead look disorganised and discontinuous. A number of other changes have been noted as well, including a decrease in fibre diameter and fibre loosening. Nerves Nerves are also damaged by RSI. Tingling feelings are caused by the compression of nerves. Nerves run through muscles, and if muscle health is poor, so is nerve health. Damaged nerves can heal but the process is extremely slow. Most cases of persisting RSI have their basis in the nerves that run from the neck, down through the shoulders, and into the wrists and hands. These nerves pass by many other structures, most notably the discs and facet joints in the neck. If the discs or muscles become damaged or tight - often due to a poor posture - then the nerves cannot move freely in the arm. If these tight nerves are then used repetitively, such as when typing or process working, they naturally become sore and inflamed. If this process is repeated before the nerve has recovered, the problem worsens. Before long it can be difficult to perform any task, even lifting a coffee cup, without feeling pain. Many different nerves course through your arms. RSI can be complicated. Because you have so many nerve fibres that exit from your neck and travel through your arm, the symptoms of this problem can vary wildly. Pain can be felt almost anywhere. Nerve-related pain is often misdiagnosed as a variety of conditions, including rotator cuff tendonitis, carpal tunnel syndrome, tennis elbow, golfer's elbow, de Quervain's Tenosynovitis . RSI Joints In the long-term, your joint posture and movement may become abnormal and result in joint pain, stiffness and premature degenerative changes. Please contact your physiotherapist for your specific individual assessment. RSI Treatment Whereas acute RSI is relatively simple to assess and treat successfully, is difficult to cure chronic RSI. Some people with RSI may eventually get a chronic pain syndrome that affects every aspect of their life. Early intervention is the key. Common RSI Treatments Early Injury Treatment Avoid the HARM Factors Acupuncture and Dry Needling Soft Tissue Massage Electrotherapy & Local Modalities Heat Packs Strength Exercises Stretching Exercises Supportive Taping & Strapping TENS Machine YogaKirti Yadav6 Likes5 Answers
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45 y/o female wakes up with these once every few months to a year with no signs nor symptoms. Mildly painful. Treats it with some herbal ointment and it resolves after a few days. I am not sure if it resolves because, or in spite of the ointment so I suggested next time leave it alone and compare. What do you suggest?Dr. Mukesh Pawar4 Likes23 Answers