Carpal Tunnel

Question 1

What causes CTS

Answer 1

compression of median nerve causing inflammation, ischemia, and nerve damage

Question 2

What are RF for CTS

Answer 2

Obesity
Pregnancy
DM
RA
Hypothyroid
Occupation (typing)

Question 3

What does the median nerve innervate (sensory)

Answer 3

Palmar thumb, index, middle, and half of ring digit

Volar back of index, middle, and ring digit

Question 4

What does the median nerve innervate (motor)

Answer 4

Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis
1-2 lumbricals

Question 5

What is the “carpal tunnel”

Answer 5

Flexor retinaculum and carpal bones enclose 9 flexor tendons and median nerve

Question 6

What factors can cause compression

Answer 6

Extrinsic: typing, cycling/motoX, sleeping position
Intrinsic: anatomically small space, fluid retention (pregnancy), over use of tendon or RA, obesity

Question 7

What are common manifestations of CTS

Answer 7

Aching to thenar area
Pain and numbness over median distribution
Dropping objects, cant open jars
Pain worse with repetitive motions or if still for too long
Sx worse at night
Pt awoken at night d/t pain
Thenar atrophy

Question 8

What is Flick Sign

Answer 8

when patient has to shade out hand to relieve symptoms

Most sensitive and specific test, most reliable

Question 9

What should you evaluate in a patient

Answer 9

thumb opposition against resistance

Sensation over median nerve distribution (firm/dull, hot/cold)

Question 10

What other tests can be done to Dx patient

Answer 10

Phalen’s (dorsum’s against each other)
Tinnel’s (percussion)
*Both, if +, indicate median neuropathy
Nerve Conduction (must do prior to sending to ortho surgeon)

Question 11

How do you treat CTS

Answer 11

NSAIDS (short course)
PT: stretch, nerve floss, postural education
Modify keyboard, computer height- avoid holding hand in flexed position
Wrist splint (minimum just at night)
+/- Steroid injection (hydrocortisone) or surgery by ortho surgeon when all else fails