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Hand pain > hand pain/ sensory deficits- Carpal Tunnel CPG > Flashcards

hand pain/ sensory deficits- Carpal Tunnel CPG Flashcards

1
Q

What diagnostic test should you do with a suspected carpal tunnel patient?

A

A evidence
Semmes- Weinstein Monofilament Testing (SMWT)- 2.83 or 3.22 for threshold of normal light touch and static 2PD (2 point discrimination) on middle finger
For mod- severe- use 3.22 to any radial finger for threshold for normal

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2
Q

What tests and measures can you administer for those suspected to have CTS

A

B evidence

Katz Hand diagram, Phalen test, Tinels sign, and carpal compression test

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3
Q

What other subjective and objective measures should you document for patients with CTS

A
  1. Age ( > 45 years)
  2. Whether shaking hands relieves their symptoms
  3. Sensory loss of the thumb
  4. Wrist ratio index ( >.67)
  5. Boston Carpal Tunnel Questionarre and Symptom Severity Scale (CTQ-SSS)- > 1.9
    Presence of 3 or more findings = acceptable diagnostic accuracy
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4
Q

What recommendation can be made about UL Neurodynamic tests? Scratch- collapse test? Tests of vibration?

A

Conflicting evidence- therefore no recommendation can be made

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5
Q

What are the outcome measures recommended for CTS? What if the patient is electing for non- surgical management?

A

B evidence

  1. CTQ- SSS- only one recommended for non surgical management
  2. CTQ- FS (Carpal tunnel questionnaire- functional scale)
  3. DASH (Disability of the Arm and Shoulder)
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6
Q

What physical performance measures are recommended for those with CTS? Surgery versus non- surgery?

A

C evidence
Surgery: DMPUT- Dellon- Modified Moberg Pick up Test
Non- surgery: PPB (Purdue Peg board)
Others: Jebsen Taylor Hand Function Test, Nine- Hold Peg Test

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7
Q

What recommendations are made about lateral pinch?

A

A evidence

Should NOT be used

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8
Q

What recommendations can be made for assessing grip strength following CTS?

A

B evidence

Should NOT be used when assessing short term <3 mo.

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9
Q

What recommendation can be made about grip strength and 3 point or tip pinch strength in suspected CTS? Post surgery?

A

C evidence- Can be used in suspected patients

D evidence- conflicting evidence following surgery

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10
Q

What recommendations are made regarding provocation testing for those with non- surgical/ surgical managed CTS?

A

C- NOT to use vibration/ threshold tests for non- surgical patients, Phalens test for surgical patients
D- conflicted evidence for 2 point discrimination and threshold testing for surgical patients

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11
Q

What recommendations can be made about assistive technology for patients with CTS

A

C evidence-

Alternative strategies- use of arrows, touch screens, alternating mouse hand, keyboards with reduced strike force

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12
Q

What orthosis recommendation can be made for CTS

A

B evidence
Neutral wrist position- worn at night for short term relief
C evidence
Can adjust wear time including day time, symptomatic, or full- time use when night- only is ineffective
can also add MCP joint immobilization to modify wrist position if no relief
Can be used for pregnant patients

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13
Q

What Biophysical Agents SHOULD/ CAN you use for CTS?

A

C evidence

  1. Trial of superficial heat for short- term relief
  2. Microwave shortwave diathermy- mild to moderate idiopathic CTS
  3. Trial of IFC for short- term relief- without pacemakers for mild to moderate CTS
  4. Phonophoresis with non- surgical management
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14
Q

What biophysical agents should NOT be used for CTS?

A

B evidence:

  1. Iontophoresis- for mild/ moderate CTS
  2. Low level Laser Therapy- or other non- laser light therapy
  3. Magnets

C evidence:
4. Thermal Ultrasound- for mild/ moderate CTS

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15
Q

What recommendation can be made about non- thermal U/S?

A

Conflicting evidence- no recommendation can be made

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16
Q

What recommendation is made for manual therapy for CTS?

A

C evidence
cervical spine and upper extremity
D evidence
Neurodynamic mobilization- conflicting evidence

17
Q

What recommendations are made regarding therex for CTS?

A

C evidence

Combined orthotic/ stretching program for those with mild/ moderate CTS without thenar artopthy and normal 2PD

18
Q

What is the prevalence for men versus women for CTS?

A

Women 2X more than men

19
Q

What forms the carpal tunnel?

A

Carpal bones and the transverse carpal ligament

20
Q

What tendons pass thru the carpal tunnel?

A

(4) FDS- Flexor digitorum superficialis
(4) FDP- Flexor digitorum profundus
Single tendon from FPL- Flexor Pollicus longus

21
Q

What is the most superficial structure in the carpal tunnel?

A

Median nerve

22
Q

What do the sensory branches do the median nerve innervate?

A

Thumb, index finger, middle, and radial half of the ring fingers

23
Q

What motor branches do the median nerve innervate?

A

the first and 2nd lumbrical muscles
Opponens pollicus
ABP- abductor pollicus brevis
Superficial portion of the flexor pollicus brevis

24
Q

What nerve innervates the thenar eminence/ carpal tunnel?

A

Palmar cutaneous branch- branches off median nerve 5cm proximal to wrist

25
Q

What nerve innervates the area of the scaphoid tubercle?

A

Lower antebrachial cutaneous

26
Q

What is the blood supply to the median nerve

A

Radial and ulnar arteries

27
Q

Other than the classic signs, what are some of the pathoanatomical features seen with CTS?

A

Can see pain, proximal to shoulder, elevated carpal tunnel pressure, ischemic nerve changes, and compression from adjacent structures

28
Q

What are some factors that lead to poor outcomes for non- surgical management?

A

Longer symptom duration, + phalen test, thenar eminence muscle wasting

29
Q

What are the best predictors for success for non- surgical management of CTS?

A

Shorter symptom duration ( < 1 year)

Lower severity of night- time symptoms

30
Q

What is the leading cause of Acute CTS? Other causes?

A

Distal radius fractures

Spontaneous bleeding, thrombosis, dislocation of metacarpal base, infection, pregnancy, fracture

31
Q

What intrinsic risk factors have the strongest link to CTS?

A

Obesity, age, female sex
Risk increases linearly with MRI and doubles with BMI > 30 kg/m, and in those > 50 y/o
Female sex increases by 1.5-4X

32
Q

What are some other intrinsic risk factors associated with CTS but to a lesser extent?

A

DM, OA, musculoskeletal disorders, estrogen replacement therapy, CV disease risk factors, hypothryoidism, family h/o CTS, lack of activity, wrist ratio > .70, wrist palm ratio > .39, short wide hand, short stature

33
Q

What are some conflicting risk factors with CTS?

A

RA, smoking, alcohol abuse, oral contraceptive use, menopause, parity, hysterectomy, or oophorectomy q

34
Q

What occupational risk factor had the strongest association with CTS?

A

Forceful hand exertions
Weaker associations with high psychological demand paired with low decision authority, vibration, prolonged off neutral wrist position, repetitive work
Computer users- not at increased risk

35
Q

What are some differential diagnostics for CTS?

A

Cervical radiculopathy, TOS, diabetic/ polyneuropathy, other median neuropathies- like pronator teres syndrome, ulnar and radial tunnel syndrome, ALS, MS

Hand pain (1 decks)

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