Wrist, Hand, and Carpel Tunnel Syndrome

Question 1

What are some reasons for hand or wrist complaints?

Answer 1

• Carpal tunnel syndrome (median distribution)
• Stenosing tenosynovitis (lateral wrist pain)
• Ulnar nerve pathology (ulnar distribution)
• Thoracic outlet syndrome

Question 2

How is tinel tap test at the wrist performed for the median nerve?
What is a positive finding and what would it indicate?

Answer 2

Examiner taps over carpal tunnel at the wrist (lunate)
Sustained paresthesia into the distal median nerve distribution indicates median neuropathy secondary to carpal tunnel syndrome

Question 3

How is tinel tap test at the wrist performed for the ulnar nerve?
What is a positive finding and what would it indicate?

Answer 3

Examiner taps over the tunnel of Guyon (between the pisiform and hook of the hamate)
Sustained paresthesia into the distal ulnar nerve distribution indicates ulnar neuropathy secondary to entrapment at the tunnel of Guyon

Question 4

What are some tests for carpal tunnel?

Answer 4

• Tinel tap at the median nerve/wrist
• Phalen’s test
• Prayer sign
• English test

Question 5

The positive/present findings for carpal tunnel orthopedic tests is always…

Answer 5

increased or sustained pain or paresthesias into the median nerve distribution of the hand
(wrist pain is not a positive or present finding)

Question 6

What structures can be found inside the carpal tunnel?

Answer 6

• Tendons of flexor digitorum profundus
• Flexor pollicis longus tendon
• Median nerve
• Tendons of flexor digitorum superfiscialis

Question 7

The carpal tunnel contains ___ tendons and ___ nerves

Answer 7

9 tendons and 1 nerve

Question 8

What are some contents found outside the carpal tunnel?

Answer 8

• Flexor carpi radialis tendon
• Flexor carpi ulnaris
• Radial artery

Question 9

Are the following found inside or outside the carpal tunnel?

• Tendons of flexor digitorum profundus
• Flexor pollicis longus tendon
• Median nerve
• Tendons of flexor digitorum superfiscialis

Answer 9

Inside

Question 10

Are the following found inside or outside the carpal tunnel?

• Flexor carpi radialis tendon
• Flexor carpi ulnaris
• Radial artery

Answer 10

Outside

Question 11

What can be found in the roof of the carpal tunnel?

Answer 11

• Flexor retinaculum
• Transverse carpal ligament
• Palmar branch of median nerve

Question 12

How is Phalen’s test (reverse prayer sign) performed?
What is a positive finding and what would it indicate?

Answer 12

Patient flexes both wrists and approximates the back of the hands firmly for about 1 minute
Paresthesias or pain into the median nerve distribution of the hand would indicate median neuropathy (carpal tunnel syndrome)

Question 13

How is prayer sign (reverse Phalen’s) performed?
What is a present finding and what would it indicate?

Answer 13

Patient extends both wrists and approximates the palms of the hands firmly for about 1 minute
Paresthesias or pain into the median nerve distribution of the hand would indicate median neuropathy (carpal tunnel syndrome)

Question 14

How is English test performed?
What is a positive finding and what would it indicate?

Answer 14

Doctor applies pressure across the ventral surface of the patient’s wrist for 1-2 minutes
Paresthesias or pain into the median nerve distribution of the hand would indicate median neuropathy (carpal tunnel syndrome)

Question 15

How is Finkelstein’s test performed?

Answer 15

1. Patient makes a fist with the thumb folded inside the fingers
2. Patient moves the fist into ulnar deviation
3. Compare asymptomatic side for baseline normal

Question 16

What is a positive finding for Finkelstein’s test and what would it indicate?

Answer 16

Pain near the radial styloid distally indicating De Quervain’s syndrome (stenosing tenosynovitis of the abductor pollicus longus and extensor pollicus brevis)

Question 17

What is De Quervain’s syndrome?

Answer 17

Stenosing tenosynovitis of the abductor pollicus longus and extensor pollicus brevis

Question 18

What is the term for stenosing tenosynovitis of the abductor pollicus longus and extensor pollicus brevis?

Answer 18

De Quervain’s syndrome

Question 19

How is Fromet’s/paper test performed?

Answer 19

1. Patient pinches a piece of paper between the thumb and the PIP joint of the index finger with the thumb adducted
2. Examiner attempts to remove the paper from the patient’s pinch

Question 20

What is a positive finding for Froment’s/paper test and what would it indicate?

Answer 20

Flexion of the thumb IP joint in order to maintain the pinch or perceived weakness indicates ulnar neuropathy with paresis of the adductor pollicus