Carpal Tunnel Syndrome (CTS) GOLD

Question 1

What is CTS?

Answer 1

peripheral nerve entrapment injury due to compression of the median nerve as it passes through the carpal tunnel.

• Results in sensory and motor disturbance in the median nerve distribution of the hand.

Question 2

Etiology

Answer 2

Exact etiology unclear

• Repetitive use
• RA; inflammation
• Pregnancy
• Diabetes
• Cumulative Trauma Disorder
• Wrist Sprain or Fracture
• Hypothyroidism

(Any condition that results in edema, inflammation, tumor or fibrosis): may lead to compression of the median nerve and result in ischemia

Question 3

Signs and Symptoms

Answer 3

Initially presents with sensory changes and paresthesia along the median nerve distribution in the hand

• (night pain)
• weakness of the hand; decreased grip strength
• Muscle atrophy
• clumsiness
• decreased wrist mobility

Question 4

Treatments; Conservative Management

Answer 4

Conservative Management:

• splinting
• ergonomic measures: assessment of an individual’s occupation, work place, leisure activities, living environment
• local corticosteroid injections

Question 5

Treatment for severe cases of CTS?

Answer 5

Carpal Tunnel Release: To decompress the median nerve

Question 6

What nerve becomes entrapped during CTS?

Answer 6

Median Nerve

Question 7

What is the normal tissue pressure within the carpal tunnel?

What can the pressure increase to in CTS?

Answer 7

Normal: 2-10 mmHg

CTS: >30 mmHg

Question 8

What Structures form the Carpal Tunnel?

Answer 8

(Carpal Bones and Flexor Retinaculum aka Transverse Carpal Ligament)

• Scaphoid Tuberosity
• Trapezium
• The Hook of Hamate
• Pisiform

Others: MEH
- Volar Radiocarpal Ligament
- Volar Ligamentous Extensions between Carpal Bones

Question 9

What Structures Run Through the Carpal Tunnel?

Answer 9

Median Nerve + 9 tendons:
- 4 Flexor Digitorum Profundus Tendons
- 4 Flexor Digitorum Superficialis Tendons
- Flexor Pollicis Longus Tendon

Question 10

What movements lead to an increase in tissue pressures in the carpal tunnel?

Answer 10

Wrist Flexion and Extension

Question 11

What age range is an individual most likely diagnosed with CTS?

Answer 11

35-55 y/o

Question 12

Which gender is most likely affected?

Answer 12

Women

Question 13

During muscle atrophy what muscle is most often noted to atrophy first?

Answer 13

Abductor Pollicis Brevis

> Then progresses to the thenar muscles <

Question 14

What laboratory finding would most likely confirm diagnosis of CTS?

Answer 14

Electromyography and Electroneurographic studies can be used diagnose a motor conduction delay along the median nerve within the carpal tunnel

Question 15

How could MRI be used to diagnose CTS?

Answer 15

MRI: Could be used to identify
- Inflammation
- Altered Tendon or Nerve Position
- Thickening of the Tendon Sheath

Question 16

What provocation testing (special tests) could be used to identify CTS?

Answer 16

• (+) Tinel’s Sign
• (+) Phalen’s Test
• (+) Tethered Median Nerve Stress Test

Question 17

What post surgical intervention techniques should be utilized for those who have undergone carpal tunnel release?

Answer 17

• Moist heat with electrical stimulation
• Iontophoresis
• Cryotherapy
• Gentle Massage
• Desensitizing of the Scar Tissue
• Tendon Gliding Exercises
• Active ROM

Question 18

What should a patient who has undergone Carpal Tunnel Release avoid?

Answer 18

• Wrist Flexion
• Forceful Grasp

Question 19

What recent pharmacological intervention has been used in the diagnosis of CTS?

Answer 19

Methylprednisolone injected proximally to the carpal tunnel

Question 20

What is the Tethered Median Nerve Stress Test

Answer 20

• Hyperextending the index finger at the distal interphalangeal joint with the wrist maintained in a supinated position.

Question 21

What time of day does pain typically occur, consistent with CTS?

Answer 21

Night Pain

Question 22

Hypo or Hyperthyroidism that is associated with CTS?

Answer 22

HYPOthyroidism; Leads to tendons being thickened and swollen. Leads to compression of the median nerve in the carpal tunnel.