Carpal Tunnel Syndrome Flashcards
Name the 5 Contents of the Carpal Tunnel
FDP FDS FPL FCR Median Nerve
Neuro Examination Findings of wrist (M. nerve)
- Sensory Loss med. n. distribution
- Motor loss - thumb abduction
- Interossei preserved
- No arm loss, sensory or power
- NO reflex loss
Neuro Examination Findings of C6
- Motor loss/reflex - biceps and brachoradialis power and reflex
- Sensory Loss - lateral forearm/hand including posterior thumb
- Preserved intrinsic function (C8/T1)
Neuro Examination Findings of C7
- Motor loss/reflex - dec triceps power and reflex
2. Sensory Loss - central post forearm and mid post hand. 2nd, 3rd, half 4th post fingers
Clinical Features of Carpal Tunnel Syndrome - History
- Weakness and loss of dexterity/clumsiness
- Feeling of swelling in fingers
- Night symptoms common - disturbs sleep
- Wake with pain, p+n
- Aggravated by overuse and sustained positions
- Flick hand for relief
- Idiopathic, gradual, progressive
- Diagnostic Tests for Carpal Tunnel
- Phalen’s
- Tinel’s
- Carpal Compression
- APB Strength
Explains Phalen’s Test
Max flexion >60sec. Reproduces symptoms in median n. distrbution, time to appear
68% Sensitivity
73% Specificity
Explain Tinel’s Test
Tap over carpal tunnel, look for paraesthesia and/or tingling in med n. distribution
50% Sensitivity
77% Specificity
Explain the Carpal Compression Test
Examiner holds supinated wrists in both hand and apply direct even pressure over med. n for up to 30sec
64% Sensitivity
83% Specificity
Explain the APB Strength Test
Resist abduction at right angle to the index finger (med n. supply) (Or thumb moving forward from palm)
29% Sensitivity
80% Specificity
What is the difference between Sensitivity and Specificity?
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)
What is Electrodiagnosis?
It is nerve conduction studies. It assesses the speed of electrical impulses as they travel down the nerve.
3 Local Contributing Factors of Carpal Tunnel
- Intercarpal Mobility/stability
- Wrist mobility/stability
- Wrist and finger flexors
2 Remote Contributing Factors of Carpal Tunnel
- Cervical Spine Mechanics
2. Thoracic Spine Mechanics
Carpal Tunnel Management - Pathology
- Splinting
- Electrotherapy
- Medication
- Injection
- Surgery
- Manual Therapy
- effleurage
- neural sliding techniques
Carpal Tunnel Management - Local Mechanical
- Carpal Mobilisation
- Retinacular Stretch
- Wrist Stability
- Neural Mobilisation
Six Aims Of Nerve (and tendon) Gliding
- Decrease oedema
- Increase venous return
- Stretch Adhesions in the CT
- Increase longitudinal area of contact between med n. and tendons/transverse carpal ligament
- Optimise longitudinal and transverse mobility
- Decrease pressure in tunnel
Carpal Tunnel Management - Remote Mechanical
- Address Upper Quadrant dec. mobility
- Address Upper Quad dec. control/stability
- Assess cervical spine - double crush
Carpal Tunnel Management - General Mechanical
- Upper Quadrant posture and function
- Activity Levels, static postures
- Regular posture breaks
- Ergonomics
