PNS tx -- median n

Question 1

nocturnal?

Answer 1

carpal tunnel

TOS

Question 2

not usually nocturnal

Answer 2

pronator teres syndrome

Question 3

carpal tunnel (as opposed to pronator teres syndrome usually) —

Answer 3

can be painful

Question 4

carpal tunnel syndrome

Answer 4

can have intense nocturnal SSx

Question 5

SLEEP POSITION MORE IMPORTANT FOR

Answer 5

CARPAL tunnel

Question 6

something patients may do to relieve carpal tunnel ssx

Answer 6

shake out their hands loosely, side to side & back and forth

Question 7

CTS some risk factors / comorbidities

Answer 7

RA
diabetes
trauma
pregnancy

other systemic conditions

Question 8

pronator teres – note possible fault of posture

Answer 8

IR GH + protracted

+
pronated RU

Question 9

pronator teres syndrome (PTS) — some mm to consider testing or palpating

Answer 9

pronator teres

pronator quadratus

supinator (antagonist)

forearm flexors in general

palpate for heat as well (more indicated for CTS)

Question 10

CTS palpate

Answer 10

HT forearm flexors?

heat?

palpate carpal bones –> e.g. scaphoid, lunate,

edema? adhesions/scar tissue / tight fascia?

point tenderness?

Question 11

PTS – MMT?

Answer 11

pronator teres

forearm flexor MMT?

Question 12

CTS – MMT?

Answer 12

forearm flexor?

grip strength?

forearm extensors?

intrinsic hand mm?

Answer 13

numbness,tingling (paresthesia)

pain & other dysesthesias

Question 14

referred pain ?

Answer 14

E.g. TrP @ pronator teres

Question 15

DDx? / rule-out?

Answer 15

TOS tests?

Question 16

CTS tests

Answer 16

phalens

reverse phalens

Question 17

myotomes?

Answer 17

rule out nerve root pathology?

Question 18

phalens /reverse phalens – positive?

Answer 18

30-60 second hold

or up until pt Sx induced

positive is not just discomfort –> but pt Sx &/or sharp pain / dysesthesia/paresthesia

Question 19

why choose reverse phalens over phalens?

Answer 19

if there is patient apprehension for phalens

if SSx are highly severe

if pt pregnant