Created at 8:58 p.m. Jan, 21, 2025
Author:
anknovice
Rationale for change
added UWorld Step 1 ID 1264 - this Q asks about a patient with CKD undergoing hemodialysis and the path present with CTS
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Text
The pathologies associated with {{c1::carpal tunnel syndrome}} may be remembered with the mnemonic "Pressing Down HARD":
H: {{c1::Hypothyroidism::thyroid disorder}}
Pressing: {{c1::Pregnancy::reproductive circumstance}} (due to edema)
Down: {{c1::Dialysis-related amyloidosis::inflammatory disorder}}
H: {{c1::Hypothyroidism::thyroid disorder}}
A: {{c1::Acromegaly::pituitary disorder}}
R: {{c1::Rheumatoid arthritis::inflammatory disorder}}
D: {{c1::Diabetes mellitus::endocrine disorder}}It may also be associated with {{c1::repetitive use}}
Extra
Dialysis-related amyloidosis: β2-microglobulin is not effectively removed by dialysis → forms amyloid which deposits in bones, joints, tendons (commonly shoulder and wrist)
Hypothyroidism: increased circulating levels of TSH stimulate fibroblasts in the connective tissue of the carpal tunnel to deposit GAGs; these attract water which cause the carpal tunnel to swell impinging the median nerve
Acromegaly: enlarged hands and feet can lead to compression of the median nerve and carpal tunnel syndrome (up to 1/3 of those with acromegaly get carpal tunnel syndrome)
Rheumatoid arthritis: deposits of antibodies (rheumatoid factor / anti-CCP antibodies) in joints of the wrist results in inflammation of median nerve
DM: circulating advanced glycation end-products (AGEs) deposit in carpal tunnel vessels deposit and cause inflammation, growth of basement membrane, and fibrosis, leading to impingement of median nerve
Hypothyroidism: increased circulating levels of TSH stimulate fibroblasts in the connective tissue of the carpal tunnel to deposit GAGs; these attract water which cause the carpal tunnel to swell impinging the median nerve
Acromegaly: enlarged hands and feet can lead to compression of the median nerve and carpal tunnel syndrome (up to 1/3 of those with acromegaly get carpal tunnel syndrome)
Rheumatoid arthritis: deposits of antibodies (rheumatoid factor / anti-CCP antibodies) in joints of the wrist results in inflammation of median nerve
DM: circulating advanced glycation end-products (AGEs) deposit in carpal tunnel vessels deposit and cause inflammation, growth of basement membrane, and fibrosis, leading to impingement of median nerve
Lecture Notes
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Missed Questions
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Pathoma
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Boards and Beyond
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First Aid
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Sketchy 2
Watch Hypothyroidism SOAP
Watch Hypothyroidism SOAP
Sketchy Extra
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Picmonic
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Pixorize
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Physeo
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OME
Additional Resources
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One by one
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