Wrist pain

Question 1

Carpal tunnel : Anatomy

Answer 1

Carpal Tunnel : narrow passage way connecting the forearm and the wrist
Consists of;
1. Transverse carpal ligament - fibrous band that wraps around palmar aspect of wrist.
2. Carpal muscles

• Site : Where median nerve travel through from forearm and innervates the wrist

Question 2

Median nerve innervation : Hand - sensory

Answer 2

Palmar aspects and full fingertips of the:
* Thumb
* Index and middle finger
* The lateral half of ring finger

Question 3

Median nerve innervation : Hand - motor

Answer 3

Muscular innervation
* Abductor pollicis brevis (thumb abduction)
* Opponens pollicis (thumb opposition – reaching across the palm to touch the tips of the fingers)
* Flexor pollicis brevis (thumb flexion)

Question 4

Carpal tunnel syndrome - Clinical presentation

Answer 4

SYMPTOMS WORSE AT NIGHT

Sensory symptoms: parenthesis, numbness, pain over;
palmar aspects and full fingertips of the:
* Thumb
* Index and middle finger
* The lateral half of ring finger

Motor symptoms
affect the thenar muscles, with:
* Weakness of thumb movements
* Weakness of grip strength
* Difficulty with fine movements involving the thumb
* Wasting of the thenar muscles (muscle atrophy)

Question 5

Carpal tunnel syndrome - Examination

Answer 5

Tests to elicit symptoms;

Phalen’s test :
Full flexion of wrist : backs of their hands together in front of them with the wrists bent inwards

Tinnel’s test
Tapping wrist over carpal tunnel

Question 6

Carpal tunnel syndrome - Investigation

Answer 6

Nerve conduction studies are the primary investigation for establishing the diagnosis.

Question 7

Cubital tunnel syndrome : Definition

Answer 7

occurs due to compression of the ulnar nerve as it passes through the cubital tunnel.
* The cubital tunnel is a space on the inner side of the elbow where the ulnar nerve passes through
* Ulnar nerve travels along the medial epicondyle of the humerus - caused by trauma to elbow/repeated elbow movement

Question 8

Cubital tunnel syndrome : Clinical presenation

Answer 8

4th and 5th finger affected
* Tingling and numbness
ulnar nerve innervates the intrinsic muscles of the hand
* Weakness and muscle wasting
* Loss of gripping and pinching strength

Pain : inner elbow down to forearm