Wrist/Hand Pathologies Flashcards
What is the most common site of nerve entrapment?
Carpal tunnel
What does the Carpal tunnel consist of?
9 flexor tendons and the median nerve
What makes the Carpal tunnel vulnerable to compression?
Decreased cross-sectional area (e.g. fracture)
Increased volume (e.g. fluid retention, synovitis)
Sustained pressure
What age range does Carpal tunnel syndrome (CTS) predominantly occur?
35-55 years of age
What is the prevalence of CTS in women?
9.2%
What is the prevalence of CTS in men?
0.6%
Classic sign of CTS
Pain, paresthesia or anesthesia in median sensory distribution
Common complaints of those with CTS
Clumsiness of the hands
Decreased prehensile grip
AM/PM symptoms of those with CTS
Pain at night due to wrist positioning
Morning stiffness or residual numbness
History of those with CTS
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)
Medical history of those with CTS
Obesity
Pregnancy
Disease processes (e.g. RA, DM, gout, renal disease)
Alcholism
Observation results from objective exam for those with CTS
Possible thenar atrophy in advanced stages
A/PROM results from objective exam for those with CTS
Grossly WNL
Strength testing results from objective exam for those with CTS
Weakness of abductor pollicis brevis
Decreased grip and pinch strength
Palpation results from objective exam for those with CTS
Unremarkable
Possible tightness in forearm
Types of sensation testing for those with CTS
Semmes-Weinstein
2-point discrimination
Special tests for CTS
Tinel's sign at wrist Phalen's test Reverse Phalen's test Carpal tunnel compression test ULNT 1 or 1a
Medical management for CTS
EMGs/ NCV testing
NSAIDs
Corticosteroid injection
Surgical intervention
Important to note about corticosteroid injections for CTS
They may be diagnostic
Types of surgical intervention for those with CTS
Endoscopic or open release
Items that help determine the prognosis of negative outcomes with conservative management according to Burton 2016
Symptoms duration
Thenar atrophy
Positive Phalen’s
Conservative management of CTS
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)
What kind of activity modifications should people with CTS do?
Avoid volar and palmar pressure, vibration, forceful gripping, and cold exposure
Types of manual therapy for those with CTS
STM to hand intrinsics
Mobilization to carpals, radiocarpal joints
Post-op management 4 days post-op
Splint at all times
Edema control
A/PROM of the fingers
Light ADL’s
Post-op management 4-14 days post-op
Splint at night
Light dressing over wound
Gentle hand/wrist/arm A/PROM
Light ADL’s
Post-op management 2-3 weeks post-op
Sutures removed 10-14 days begin scar massage Head modalities PRN Discontinue splint Continue activity modification if indicated A/PROM continues Initiate light strengthening
Post-op management 3 months post-op
Return to full PLOF
What are other post-operative considerations to take into account for those with CTS
Patient education and activity modifications
