Carpal Tunnel Syndrome

Question 1

Name the 5 Contents of the Carpal Tunnel

Answer 1

FDP
FDS
FPL
FCR 
Median Nerve

Question 2

Neuro Examination Findings of wrist (M. nerve)

Answer 2

1. Sensory Loss med. n. distribution
2. Motor loss - thumb abduction
3. Interossei preserved
4. No arm loss, sensory or power
5. NO reflex loss

Question 3

Neuro Examination Findings of C6

Answer 3

1. Motor loss/reflex - biceps and brachoradialis power and reflex
2. Sensory Loss - lateral forearm/hand including posterior thumb
3. Preserved intrinsic function (C8/T1)

Question 4

Neuro Examination Findings of C7

Answer 4

1. Motor loss/reflex - dec triceps power and reflex

2. Sensory Loss - central post forearm and mid post hand. 2nd, 3rd, half 4th post fingers

Question 5

Clinical Features of Carpal Tunnel Syndrome - History

Answer 5

1. Weakness and loss of dexterity/clumsiness
2. Feeling of swelling in fingers
3. Night symptoms common - disturbs sleep
4. Wake with pain, p+n
5. Aggravated by overuse and sustained positions
6. Flick hand for relief
7. Idiopathic, gradual, progressive

Question 6

4. Diagnostic Tests for Carpal Tunnel

Answer 6

1. Phalen’s
2. Tinel’s
3. Carpal Compression
4. APB Strength

Question 7

Explains Phalen’s Test

Answer 7

Max flexion >60sec. Reproduces symptoms in median n. distrbution, time to appear
68% Sensitivity
73% Specificity

Question 8

Explain Tinel’s Test

Answer 8

Tap over carpal tunnel, look for paraesthesia and/or tingling in med n. distribution
50% Sensitivity
77% Specificity

Question 9

Explain the Carpal Compression Test

Answer 9

Examiner holds supinated wrists in both hand and apply direct even pressure over med. n for up to 30sec
64% Sensitivity
83% Specificity

Question 10

Explain the APB Strength Test

Answer 10

Resist abduction at right angle to the index finger (med n. supply) (Or thumb moving forward from palm)
29% Sensitivity
80% Specificity

Question 11

What is the difference between Sensitivity and Specificity?

Answer 11

Sensitivity is a % of cases picked up that actually have it. It gives false positives.
Specificity is a % of those who have it and are picked up. But misses some (false negatives)

Question 12

What is Electrodiagnosis?

Answer 12

It is nerve conduction studies. It assesses the speed of electrical impulses as they travel down the nerve.

Question 13

3 Local Contributing Factors of Carpal Tunnel

Answer 13

1. Intercarpal Mobility/stability
2. Wrist mobility/stability
3. Wrist and finger flexors

Question 14

2 Remote Contributing Factors of Carpal Tunnel

Answer 14

1. Cervical Spine Mechanics

2. Thoracic Spine Mechanics

Question 15

Carpal Tunnel Management - Pathology

Answer 15

1. Splinting
2. Electrotherapy
3. Medication
4. Injection
5. Surgery
6. Manual Therapy
   
   • effleurage
   • neural sliding techniques

Question 16

Carpal Tunnel Management - Local Mechanical

Answer 16

1. Carpal Mobilisation
2. Retinacular Stretch
3. Wrist Stability
4. Neural Mobilisation

Question 17

Six Aims Of Nerve (and tendon) Gliding

Answer 17

1. Decrease oedema
2. Increase venous return
3. Stretch Adhesions in the CT
4. Increase longitudinal area of contact between med n. and tendons/transverse carpal ligament
5. Optimise longitudinal and transverse mobility
6. Decrease pressure in tunnel

Question 18

Carpal Tunnel Management - Remote Mechanical

Answer 18

• Address Upper Quadrant dec. mobility
• Address Upper Quad dec. control/stability
• Assess cervical spine - double crush

Question 19

Carpal Tunnel Management - General Mechanical

Answer 19

• Upper Quadrant posture and function
• Activity Levels, static postures
• Regular posture breaks
• Ergonomics