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Carpal Tunnel Syndrome and

Peripheral Neuropathies

Dr. Arvind N Prabhu

Assistant Professor
Department Of Neurology
KMC, Manipal
Peripheral Neuropathy
• Peripheral neuropathy is the term for damage to
nerves of the peripheral nervous system, which
may be caused either by diseases of the nerve or
from the side-effects of systemic illness.
• Peripheral nervous system
is composed of 12 pairs of
cranial nerves and 31 pairs
of spinal nerves.
Peripheral Nerve
The peripheral nervous system is made up of three main types of
nerves, each with its own specific function:
- Automatic nerves help regulate the automatic functions of the body,
such as blood pressure, bladder function and sweat levels.
- Motor nerves control the muscles of the body.
- Sensory nerves pass sensations, such as cold, heat or pain, from the
affected area of the body to the brain.
Peripheral neuropathy may be classified in a
varieties of ways-
• according to the number of nerves affected---
• Mononeuropathy
• Mononeuritis multiplex
• Polyneuropathy
• the type of nerve cell affected----
• motor
• sensory
• autonomic
• the process affecting the nerves-----
• Demyelinating
• Axonal
• Neuronal
• Mononeuritis multiplex -----

• is simultaneous or sequential involvement of individual

noncontiguous nerve trunks, either partially or completely, evolving
over days to years and typically presents with acute or subacute loss
of sensory and motor function of individual peripheral nerves.
• Polyneuropathy-
• The term "peripheral neuropathy" is sometimes used loosely to refer
to polyneuropathy.
• Most cases of peripheral neuropathy affect the sensory and motor
• Longest fibers are affected first so symptoms usually first develop in
the extremities of your body, such as your feet, legs and hands and
arms. This type of neuropathy is called generalized sensorimotor
Acute Chronic

Guillain-Barré Hereditary
Alcohol CIDP
Guillain-Barré variants Lymphoma
Toxins Osteoclastic myeloma
Porphyria IgM paraproteinaemia
Paraneoplastic Arsenic toxicity
Amiodarone toxicity
Metabolic/endocrine diseases
(including diabetes)
Drugs and toxins
Vitamin deficiency
IgG paraproteinaemia
Primary amyloidosis
• A - Alcohol, Arsenic toxicity
• B - Vit.deficiency-B1,6,12 def.
• C - CRF, Carcinomatous –lymphoma, myeioma; connective tissue
• D - Diabetes, Drugs-INH, Metronidazole
• G- GBS

• H-Hereditary
• I-Infection-leprosy,
• Sensorimotor polyneuropathy
• Symptoms of generalized sensorimotor polyneuropathy can include:
• prickling and tingling sensation in the affected body part (pins and
• numbness and a reduced ability to feel pain or changes in
temperature, particularly in your feet
• a burning pain, usually in the feet and legs, followed by the hands and
arms as the neuropathy progresses
• sharp stabbing pain, which is often worse at night (again, the feet and
legs are affected first, followed by the hands and arms)
• It depends on the types, severity and nerve cells involved.
• Motor signs- lower motor neuron lesion-wasting ,fasciculation and
loss of reflexes
• Sensory signs-diminished or loss of sensation of all modalities of
• Diagnosis- is largely clinical, supported by electrical studies.

• A number of tests can be used to confirm peripheral neuropathy .

These include:

• nerve conduction test (NCS) and electromyography (EMG)

• nerve biopsy
• Treatment for peripheral neuropathy will first address the condition’s
underlying causes.
• For example, in cases of diabetic polyneuropathy, a number of
lifestyle changes and treatment are taken to prevent further nerve
damage. This may be:
• giving up smoking
• cutting down on your alcohol consumption, or ideally not drinking
alcohol at all
• maintaining a healthy weight, if you are overweight or obese
• taking plenty of exercise
• tight glycemic control
• Mono and Poly
• Entrapment
• Demyelinating
• Axonal
• Mononeuritis multiplex

• d/d: NMJ, Plexus, Anterior Horn Cell, Neuronopathy, Myopathy,

• Etiology: Disease or injury

•Carpal tunnel syndrome, the most common

focal peripheral neuropathy, results from
compression of the median nerve at the
• Entrapment neuropathy
Pain and
functions of
• Pain
• Numbness
• Tingling
• Symptoms are usually worse at night and can awaken patients from
• To relieve the symptoms, patients often “flick” their wrist as if
shaking down a thermometer (flick sign).
• Phalen’s maneuver
• Tinel’s sign
• weak thumb abduction.
• two-point discrimination
• Comorbidities associated with the development of CTS include
diabetes and obesity.
• Although a high rate of repetitive hand/wrist motions is a risk factor.
Carpal Tunnel Syndrome
Two main pathomechanisms include—
• increased hydrostatic pressure within the carpal tunnel (carpal tunnel
pressure) and
• contact stress (or impingement)

• Forearm, wrist, and finger postures, as well as fingertip force have

significant effects on carpal tunnel pressure.

• Contact stress on the median nerve is mainly a product of wrist

posture and musculotendinous loading.
• History
• Physical examination
• Nerve Conduction Study
• Predicting the Outcome of Conservative Treatment
• Avoid repetitive wrist and hand motions that may exacerbate
symptoms or make symptom relief difficult to achieve.
• Not use vibratory tools
• Ergonomic measures to relieve symptoms depending on the
motion that needs to be minimized
• Probably most effective when it is
applied within three months of the
onset of symptoms
Thank You…