carpal tunnel syndrome
TRANSCRIPT
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CARPAL T
UNNEL
SYNDROME
BY
AB
U I
BR
AH
I M A
ND
CH
AD
JO
HN
SO
N
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The carpal bones of the wrist form a convex arch on the dorsal side of the hand and concave on the palmar side. On the palmar side it is covered by the flexor retinaculum.
ANATOMY
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ANATOMY CONTINUED
A total of nine tendons pass through the carpal tunnel:
• Flexor Digitorum Profundus (four tendons)
• Flexor Digitorum Superficialis (four tendons)
• Flexor Pollicis Longus (one tendon)
Also the Median Nerve passes through the tunnel between the flexor digitorum profundus and flexor digitorum superficialis tendons.
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GENDER DIFF
ERENCE IN
CARPAL T
UNNEL
COMPLIA
NCE
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OVERVIEW OF INJURY
Median nerve entrapment most commonly occurs in the carpal tunnel, however it can also be occluded as it passes under the scalenes entering the arm.
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OVERVIEW OF INJURY
Carpal Tunnel Syndrome is a neuropathy caused by the entrapment of the median nerve by the within the tunnel by the flexor tendons with and the transverse carpal ligament
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HISTORY
Symptoms:
-Dull/achy discomfort in hand, forearm, or upper arm
-Paraesthesia in hand (1st-3rd digits)
-WEAKNESS
-Swelling or discoloration of hand
-Night pain
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HISTORY
Potential Causes:
-Repetitive motions of hand and wrist (flexion/extension)
-Sustained arm or hand positions
-Pregnancy
-Vibration ergonomics
-Congenital Predisposition
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CARPAL T
UNNEL
SYNDROME A
ND
KEYBOARD U
SE AT
WORK:
A POPU
LATI
ON-BASED
STUDY
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AN MRI E
VALU
ATIO
N OF
CARPAL T
UNNEL IN
HEALTHY
WRIS
TS:
IMPL
ICAT
IONS F
OR
CARPAL T
UNNEL
SYNDROME
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SPECIAL TESTS
• Phalen's maneuver -- Performed by flexing the wrist gently as far as possible, then holding this position and awaiting symptoms. A positive test is one that results in numbness in the median nerve distribution when holding the wrist in flexed position within 60 seconds. The quicker the numbness starts, the more advanced the condition. Phalen's sign is defined as pain and/or paresthesias in the median-innervated fingers with one minute of wrist flexion.
• Durkan test - carpal compression test, or applying firm pressure to the palm over the nerve for up to 30 seconds to elicit symptoms
• Tinel's sign
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INSPECTION / PALPATION
-No gross deformity
-Usually no discoloration/ visible edema
-May present with decreased mass in thenar eminence compared bilaterally
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TREATMENT - CONSERVATIVE
1.Modification of ADLs
2.Drugs (NSAIDs, steroid injection)
3.Ultrasound
4.Hand and wrist splinting
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THE C
OMPARAT
IVE
EFFE
CTIVENES
S
OF TE
NDON AND N
ERVE GLID
ING
EXERCIS
ES IN
PATI
ENTS W
ITH
CARPAL T
UNNEL S
YNDROME: A
RANDOMIZED T
RIAL
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COMPARIS
ON OF
A TARGET
ED A
ND
GENERAL MASSAGE
PROTO
COL ON
STREN
GTH, F
UNCTION, A
ND
SYMPT
OMS ASSOCIA
TED W
ITH
CARPAL T
UNNEL S
YNDROME: A
RANDOMIZED P
ILOT
STUDY
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STATI
C MAGNETI
C FIE
LD
FOR C
ARPAL T
UNNEL
SYNDROME: A
FEASIB
ILITY
STUDY
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EFFIC
ACY OF
A SOFT
HAND B
RACE
AND A W
RIST
SPLIN
T FO
R CARPA
L
TUNNEL
SYNDROME:
A
RANDOMIZED C
ONTROLL
ED STU
DY
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TREATMENT – SURGICAL
-Surgical intervention involves the release of the transverse carpal ligament to release pressure within carpal tunnel.
-OPEN vs. ENDOSCOPIC
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SURGICAL D
ECOMPRESSIO
N
VERSUS LO
CAL STE
ROID IN
JECTI
ON
IN C
ARPAL T
UNNEL SYN
DROME - A
ONE-YEA
R, PROSPE
CTIVE,
RANDOMIZED, O
PEN, C
ONTROLL
ED
CLINIC
AL TRIA
L
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DIFFERENTIAL DIAGNOSES
Cervical radiculopathy (especially C6–C7)
• Brachial plexopathy (in particular of the upper trunk)
• Proximal median neuropathy (especially at the pronator teres level)
• Thoracic outlet syndrome
• CNS disorders
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REHABILITION
- STM 7-10min ( Mostly effleurage to remove excess fluid)- PROM wrist all directions- Wrist FLEX/EXT/SUP-PRO 3x10- Wrist FLEX/EXT stretches 3x30sec- Ice and E-stim 80-150pps x 10 mins (For pain control)
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RETURN TO PLAY CRITERIA
• No Pain• No CTS Symptoms – negative
Phalen’s Test• Full ROM and Strength