Wrist/Hand Pathologies

Question 1

What is the most common site of nerve entrapment?

Answer 1

Carpal tunnel

Question 2

What does the Carpal tunnel consist of?

Answer 2

9 flexor tendons and the median nerve

Question 3

What makes the Carpal tunnel vulnerable to compression?

Answer 3

Decreased cross-sectional area (e.g. fracture)
Increased volume (e.g. fluid retention, synovitis)
Sustained pressure

Question 4

What age range does Carpal tunnel syndrome (CTS) predominantly occur?

Answer 4

35-55 years of age

Question 5

What is the prevalence of CTS in women?

Answer 5

9.2%

Question 6

What is the prevalence of CTS in men?

Answer 6

0.6%

Question 7

Classic sign of CTS

Answer 7

Pain, paresthesia or anesthesia in median sensory distribution

Question 8

Common complaints of those with CTS

Answer 8

Clumsiness of the hands

Decreased prehensile grip

Question 9

AM/PM symptoms of those with CTS

Answer 9

Pain at night due to wrist positioning

Morning stiffness or residual numbness

Question 10

History of those with CTS

Answer 10

Typically gradual onset, worsening over time
Overuse injuries
Recent increased use of crutches
Chronic pressure (e.g. cyclists)
Repetitive vibration (e.g. use of jackhammer)

Question 11

Medical history of those with CTS

Answer 11

Obesity
Pregnancy
Disease processes (e.g. RA, DM, gout, renal disease)
Alcholism

Question 12

Observation results from objective exam for those with CTS

Answer 12

Possible thenar atrophy in advanced stages

Question 13

A/PROM results from objective exam for those with CTS

Answer 13

Grossly WNL

Question 14

Strength testing results from objective exam for those with CTS

Answer 14

Weakness of abductor pollicis brevis

Decreased grip and pinch strength

Question 15

Palpation results from objective exam for those with CTS

Answer 15

Unremarkable

Possible tightness in forearm

Question 16

Types of sensation testing for those with CTS

Answer 16

Semmes-Weinstein

2-point discrimination

Question 17

Special tests for CTS

Answer 17

Tinel's sign at wrist
Phalen's test
Reverse Phalen's test
Carpal tunnel compression test
ULNT 1 or 1a

Question 18

Medical management for CTS

Answer 18

EMGs/ NCV testing
NSAIDs
Corticosteroid injection
Surgical intervention

Question 19

Important to note about corticosteroid injections for CTS

Answer 19

They may be diagnostic

Question 20

Types of surgical intervention for those with CTS

Answer 20

Endoscopic or open release

Question 21

Items that help determine the prognosis of negative outcomes with conservative management according to Burton 2016

Answer 21

Symptoms duration
Thenar atrophy
Positive Phalen’s

Question 22

Conservative management of CTS

Answer 22

Activity modification
Ergonomic consult
Splinting (to manage nocturnal symptoms)
Tendon gliding
Nerve glides
Modalities (e.g. US, contrast baths, laser)
Manual therapy (local and proximal)

Question 23

What kind of activity modifications should people with CTS do?

Answer 23

Avoid volar and palmar pressure, vibration, forceful gripping, and cold exposure

Question 24

Types of manual therapy for those with CTS

Answer 24

STM to hand intrinsics

Mobilization to carpals, radiocarpal joints

Question 25

Post-op management 4 days post-op

Answer 25

Splint at all times
Edema control
A/PROM of the fingers
Light ADL’s

Question 26

Post-op management 4-14 days post-op

Answer 26

Splint at night
Light dressing over wound
Gentle hand/wrist/arm A/PROM
Light ADL’s

Question 27

Post-op management 2-3 weeks post-op

Answer 27

Sutures removed 10-14 days
begin scar massage
Head modalities PRN
Discontinue splint
Continue activity modification if indicated
A/PROM continues
Initiate light strengthening

Question 28

Post-op management 3 months post-op

Answer 28

Return to full PLOF

Question 29

What are other post-operative considerations to take into account for those with CTS

Answer 29

Patient education and activity modifications