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% Document Info
\author{Siffi (Siffi)}
\pdfinfo{
  /Title (carpal-tunnel-syndrome-cts.pdf)
  /Creator (Cheatography)
  /Author (Siffi (Siffi))
  /Subject (Carpal Tunnel Syndrome (CTS) Cheat Sheet)
}

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\fancyhead[L]{
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
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    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Carpal Tunnel Syndrome (CTS) Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Siffi (Siffi)} via \textcolor{DarkBackground}{\uline{cheatography.com/122609/cs/25917/}}}
\end{tabulary}
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\fancyfoot[L]{ \footnotesize
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
  \SetRowColor{FootBackground}
  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Siffi (Siffi) \\
  \uline{cheatography.com/siffi} \\
  \end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 7th May, 2021.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
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  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
\raggedright
\raggedcolumns

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% www.emerson.emory.edu/services/latex/latex_169.html
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Anatomy}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{17.67cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/siffi_1620407417_Picture1-8.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{- Tendons of FDS, FDP, median nerve, FPL pass under the flexor retinaculum \newline - Palmar cutaneous branch of ulnar, PL tendon, ulnar artery  and nerve and palmar cutaneous branch of median nerve pass over the carpal tunnel}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Demographics}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Most common nerve entrapment} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Females more likely to be affected than males} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- More prevalent in white adults} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- More common in dominant hand} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Rare in developing countries (work is not as repetitive)} \tn 
% Row Count 6 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Risk Factors}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Prolonged wrist flexion/extension} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Repetitive wrist movements} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Exposure to vibration/cold} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Diabetes} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Hypothyroidism} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- RA} \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Increased BMI} \tn 
% Row Count 7 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Renal disease} \tn 
% Row Count 8 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Thicken transverse ligament} \tn 
% Row Count 9 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Short stature} \tn 
% Row Count 10 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Trauma} \tn 
% Row Count 11 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- OA} \tn 
% Row Count 12 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Pregnancy} \tn 
% Row Count 13 (+ 1)
% Row 13
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- CONSIDER ISCHEMIA (CAD)} \tn 
% Row Count 14 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Presentation}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Paraesthesia in palmar 3 1/2 fingers (median nerve)} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Night symptoms (increased hand volume) - patient complains of having to "wake up and shake it off"} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Pain over carpal tunnel} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Patients often think their whole hand is numb (poor localisation)} \tn 
% Row Count 7 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Pain can refer to the elbow} \tn 
% Row Count 8 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Palm symptoms indicate higher up involvement (pronator teres, TOS) as palmar cutaneous branch travels outside of the carpal tunnel} \tn 
% Row Count 11 (+ 3)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Symptoms aggravated by gripping activities} \tn 
% Row Count 12 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Hand weakness/atrophy may occur of the hand (thenar - ape hand)} \tn 
% Row Count 14 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Patient complains of dropping things (decreased sensation)} \tn 
% Row Count 16 (+ 2)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- May have autonomic symptoms (tight swollen feeling, skin colour changes, hand temperature changes} \tn 
% Row Count 18 (+ 2)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Hypertonicity of Cx, scalene, pecs, pronator and wrist flexors} \tn 
% Row Count 20 (+ 2)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- ROM may not be affected but can reproduce complaint in flexion/extension - consider lunate} \tn 
% Row Count 22 (+ 2)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Limited active thumb abduction} \tn 
% Row Count 23 (+ 1)
% Row 13
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Look for cutaneous findings (ulcerations, blistering, sclerodactyly, nail dystrophy)} \tn 
% Row Count 25 (+ 2)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- +ve Tinels, Phalens , Manual Carpal compression (most sensitive)} \tn 
% Row Count 27 (+ 2)
% Row 15
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Numbness of 5th digit/dorsum , consider neuropathy of alternate origin} \tn 
% Row Count 29 (+ 2)
% Row 16
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Weakness in LOAF muscles (1st and 2nd lumbricals, Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis) - Pinch grip} \tn 
% Row Count 32 (+ 3)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Presentation (cont)}}  \tn
% Row 17
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Consider double crush - Cervical arthropath, Cx disc, TOS, Pronator syndrome} \tn 
% Row Count 2 (+ 2)
% Row 18
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Consider other structures - ligament of Struthers, lacertus fibrosis} \tn 
% Row Count 4 (+ 2)
% Row 19
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Bilateral hand involvement - central cord lesion until proven otherwise (MRI)}}} \tn 
% Row Count 6 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{CPR}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Least 4 of the 5 findings:}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Shaking hands to relieve symptoms} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Wrist rate \textgreater{}.67 (thickness to the width)} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Symptom severity scale \textgreater{}1.9} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Diminished sensation in thumb} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Age \textgreater{}45 years old} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Imaging}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Imaging only needed if bony compression is suspected} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- MRI can be used to determine Cx radiculopathy/soft tissue pathology} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- US (more sensitive than MRI)} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- EMG} \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{DDx}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Cx radiculopathy} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- TOS} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Compartment syndrome} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Diabetic neuropathy} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Lateral/medial epicondylitis} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- MS} \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Regional pain syndrome} \tn 
% Row Count 7 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- SOL - Flexor tenosynovitis/ganglions} \tn 
% Row Count 8 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Management}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Myofascial release of forearm, wrist and hand - pronator, wrist flexors and carpal tunnel} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Median nerve flossing} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- SMT of Cx or carpal restrictions} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Kinesiotape} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Splinting (night pain)} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Home exercsies - Cx spine, scalene, pecs, pronator and wrist flexors, chin retraction, carpal tunnel mobilisation, median nerve glide and floss} \tn 
% Row Count 9 (+ 3)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Advise rest - avoidance of repetitive wrist flexion/extension} \tn 
% Row Count 11 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Vitamin B6} \tn 
% Row Count 12 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Weight loss if obese} \tn 
% Row Count 13 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Patients with significant motor deficits/not improving with conservative care consider referral for injections/surgery} \tn 
% Row Count 16 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Factors of success of conservative care: \newline 1.Age \textgreater{}50 years \newline 2. Duration \textgreater{}10 years \newline 3. Constant paraesthesia \newline 4. Stenosing flexor tenosynovitis \newline 5. +ve Phalens test in \textgreater{}30 seconds \newline \textgreater{}2 factors - conservative management successful in 83\% of cases \newline if 3 - 7\% success \newline if 4 or 5 - 0\% success}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}



\end{document}