Hand And Wrisr Flashcards
What is carpal tunnel syndrome?
Entrapment neuropathy of the upper limb where there is a compression of the median nerve in the carpal tunnel region of the wrist.
What are the symptoms of carpal tunnel syndrome?
Characterised as a pins and needles sensation in the distribution of the median nerve - palmar surface of the hand and digits 1-3 and the radial half of the 4th digit. Pain may radiate to the shoulder.
What is normal in carpal tunnel syndrome?
Sensations over the thenar eminence are normal due to its nerve supply being the palmar cutaneous branch of the median nerve, which branches off before the carpal tunnel.
Who is commonly affected by carpal tunnel syndrome?
Common in manual workers.
When do symptoms of carpal tunnel syndrome typically appear?
Symptoms appear after activity using the hands and wrist.
What can happen to patients at night with carpal tunnel syndrome?
Symptoms may wake the patient at night, prompting them to shake their hands and change body position to alleviate symptoms.
What is a reported weakness in carpal tunnel syndrome?
Weakness and fine motor action of the affected hand, such as undoing buttons (later stages).
What are key neurological examination findings in carpal tunnel syndrome?
Changes in the distribution of the median nerve and not in a dermatomal pattern.
What muscular findings are associated with carpal tunnel syndrome?
Hypertonic and tender musculature in the thenar eminence, abductor pollicis brevis, and flexor pollicis brevis.
What movements reproduce symptoms in carpal tunnel syndrome?
In AROM, voluntary movements reproduce numbness, tingling, or pain in median nerve distribution, such as wrist flexion, wrist extension, and thumb opposition and abduction.
What is the purpose of PROM in carpal tunnel syndrome?
To determine if structural issues or joint stiffness are contributing to symptoms.
What is a common grip strength issue in carpal tunnel syndrome?
Weakness in grip strength leading to clumsiness and decreased fine motor control.
What happens to the thenar eminence in later stages of carpal tunnel syndrome?
Atrophy of the thenar eminence.
What tests are positive in carpal tunnel syndrome?
+ in carpal compression, Phalen’s test, and Tinel’s sign at the carpal tunnel.
What tests may be referred for in carpal tunnel syndrome?
Referral for nerve conduction tests (NCS) or EMG to help decide whether a patient is a surgical candidate.
What is a conservative management approach for carpal tunnel syndrome?
Conservative osteopathic treatment including soft tissue, articulation, MET, and consideration of the pathway of the median nerve.
What is important in load management for carpal tunnel syndrome?
Decreasing repetitive movements and ergonomic advice.
What is the purpose of splinting or bracing in carpal tunnel syndrome?
To decrease excessive flexion and extension positions of the wrist, particularly at night.
What type of exercises are recommended for rehabilitation in carpal tunnel syndrome?
Nerve gliding exercises and motor control and endurance exercises for the forearm flexors.
