Dr. Ebraheim’s educational animated video describes the condition of diabetes & carpal tunnel syndrome.
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Diabetes & Carpal Tunnel Syndrome
Approximately 20% of diabetics will develop carpal tunnel syndrome. It is believed that patients with diabetic neuropathy will have a high prevalence of carpal tunnel syndrome. EMG and nerve studies (electrodiagnostic testing) cannot distinguish patients which clinical carpal tunnel syndrome from patients with diabetic polyneuropathy. When treating the patient, try to figure out the patient’s blood sugar level. There may be difficulty in determining if the blood sugar is under control. The Glycosylated Hemoglobin Test (Hemoglobin A1c) is an important blood test that shows how well the diabetes is being controlled. The normal range of Hemoglobin A1c is between 4% and 5.6%. When the level is 6.5% or higher, this indicates diabetes. The goal of treatment is to make sure that the patient with diabetes has Hemoglobin A1c less than 7%. The higher the level of Hemoglobin A1c, the higher the risk of developing complications. Identify the four types of patients who may develop complications in orthopedics: diabetic patients, obese patients, heavy smokers, and patients who are taking blood thinners. If the condition is acute or an emergency, we have to do surgery. If the condition is elective, then surgery can wait. If the patient has poor glycemic control, then you probably do not want to perform elective surgery on the patient such as carpal tunnel release. High blood sugar is linked to increased wound complications after surgery. Hemoglobin A1c is used to monitor the patient’s blood sugar level. The higher preoperative Hemoglobin A1c level, the more there is a risk factor for surgical site infection. Carpal tunnel surgery is a small surgery, but it can have a catastrophic effect if we do not have good control of the patient’s diabetes. This can cause complications and infection proving that high HA1c levels is a true risk factor for infection postoperatively. Elective surgery should have been delayed until the HA1c levels could be controlled.
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