Dr. Ebraheim’s educational animated video describing the relationship between Carpal Tunnel Syndrome and diabetes.
Approximately 20% of diabetics will develop carpal tunnel syndrome. Peripheral neuropathy makes the condition of carpal tunnel syndrome worse.
It is suggested that the nerve that already has established hypoxia caused by diabetes is more vulnerable to local compression. Other mechanisms and explanations are also involved (difficult diagnosis). 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 patient which clinical carpal tunnel syndrome from patients with diabetic polyneuropathy. The decision to treat these patients should be made independently of the electrodiagnostic findings. The electrodiagnostic discrimination of carpal tunnel syndrome due to neuropathy is not certain or clear.
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 test provides an average blood sugar control over the last 2-3 months. 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 treatments 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. people should have the test done every three months to check and see that their blood sugar is under control. At minimum, the hemoglobin A1c test should be done twice per year.
Challenging problems
•Difficulty in diagnosis
•Difficulty in determining if the diabetes is being controlled or not
•If I am going to do surgery, will the patient have complications?
Identify four types of patients who may develop complications in orthopedics
•Diabetic
•Obese patient
•Heavy smoker
•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. Need to hit the pause button and sort things out. Need to analyze the situation and come up with a plan.
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 us 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 of infection. Elective surgery can be delayed until the HbA1c level become normal. Joint replacement surgery for example is delayed until the hemoglobin A1c levels are less than 7%. Since carpal tunnel syndrome is common with diabetic patients, we need to take time to sort things out with these conditions. We need to know that the patient has better control of their diabetes.
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. Hemoglobin A1c will help us monitor the patient.
The patient is getting Acell treatment: stem cell powder to help in improving granulation tissue. This case shows that an elective surgery such as carpal tunnel release can cause the patient problems due to high HbA1c levels. This can cause complications and infection proving that high HbA1c levels are a true rick factor for infection postoperatively. Elective surgery should have been delayed until the HbA1c levels could be controlled.
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