Carpal Tunnel Syndrome

Compression of median nerve in the carpal tunnel causing numbness, tingling sensation and weakness in hand.

EPIDEMIOLOGY

Mostly affects women than men typically affects women aged between 40-60 years of age with incidence rate most common entrapment neuropathy prevalence rate is 1 in 25 cases. The reported prevalence of carpal tunnel syndrome is between 1% and 7% in European population studies

CAUSES

Repetitive motion overuse injury like typing, playing piano awkward positioning of hand while using keyboard, mouse. Other medical conditions can lead to carpal tunnel syndrome viz

Diabetes

Thyroid dysfunction(hypothyroidism)

Fracture of wrist

Pregnancy due to edema or fluid retention

CLINICAL FEATURES AND PATHOPHYSIOLOGY

Pain, Numbness, Tingling, Burning Sensation in the hand leading to weakness of hand tingling and numbness sensation is felt on thumb, index and middle finger i.e along the distribution of median nerve These symptoms often occur while holding a steering wheel, phone or newspaper. The sensation may wake you from sleep. Patients often tends to “shake out” hand in order to relieve symptoms. Symptoms also disturbs sleep and aggravates early in the morning while waking up.

Median nerve is compressed due to hypertrophy of flexor synovium
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PHYSICAL EXAMINATION AND DIAGNOSIS

Following Physical examination tests are performed to evaluate carpal tunnel syndrome.

Tinel’s Sign

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Phalen’s test

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Reverse Phalen Test

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Other tests includes Carpal Compression Test, Electromyography and Nerve Conduction Studies Ultrasound exam reveals palmar bowing of flexor retinaculum and ultrasound and MRI reveals enlargement of median nerve at the level of pisiform

DIFFERENTIAL DIAGNOSIS

Neuralgic amyotrophy

Brachial plexus injury

Multiple Sclerosis

Cervical Syringomyelia

Pancoast tumor

MEASURES

DASH (Disability of shoulder and hand questionnaire)

BCTQ (Boston Carpal tunnel questionnaire)

MHQ (Michigan Hand Outcome questionnaire)

PEM (Patient Evaluation Measures)

PHYSIOTHERAPY MANAGEMENT

Surgical management includes decompression surgery which comprises of two types (a) open carpal tunnel release OCTR and (b) endoscopic carpal tunnel release

Medical management includes Corticosteroid injection in the carpal tunnel, NSAIDS, Splinting

Physiotherapy includes ergonomic modifications, carpal bone and nerve mobilisation, ultrasound therapy, electromagnetic therapy and splinting. Carpal tunnel rehabilitation exercises includes
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for more information visit

https://www.physio-pedia.com/Carpal_Tunnel_Syndrome

https://www.physiocheck.co.uk/condition/46/carpal-tunnel-syndrome

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Tennis Elbow aka Lateral Epicondylitis

also known as lateral epicondylitis defined as inflammation of tendon of extensor compartment of forearm specifically extensor carpi radiallis brevis (ECRB)

EPIDEMIOLOGY AND CAUSES

often results from overuse injury with sporting activities like ratchet sports tennis, squash and other sports like cricket, baseball etc most popular example among sports athletes is Sachin Tendulkar suffered from this disease in general survey annual incidence is 1-3% of the U.S. population. Men and women are equally affected. Typically, lateral epicondylitis affects individuals greater than age 40 years.

CLINICAL FEATURES AND PATHOPHYSIOLOGY

Pain in the lateral compartment of forearm along with tenderness at a point distal to origin of ECRB pain may radiate to posterior aspect of forearm and aggravates with activities like repetitive extension long standing pain may result in weakness of extensor muscles and a characteristic” coffee cup sign” i.e holding coffee cup may trigger pain is observed

Overuse action of extensor muscles may lead to micro tears of the extensor tendon leading to degenerative changes.

PHYSICAL EXAMINATION AND DIAGNOSIS

Following physical examination tests are performed to evaluate tennis elbow

COZEN TEST

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MILL’S  TEST

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Other test includes

MAUDSLEY TEST

CHAIR TEST

WRINGING TEST

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Other diagnostic tools such as ultrasound may reveal micro tears of the tendon and extent of tendon damage X-ray reveal calcification and MRI is used to rule out arthritis

DIFFERENTIAL DIAGNOSIS

Cervical Radiculopathy

Posterior Introsseous syndrome

Radial tunnel syndrome

Fibromyalgia

Elbow Osteoarthritis

MEASURES

Patient Rated Tennis Elbow Evaluation

Visual analogue Scale

QUICKDash(Disability of Arm Shoulder Hand)

PHYSIOTHERAPY MANAGEMENT

Medical management includes Corticosteroid injection at the extensor origin and NSAIDS which helps to relieve pain Physiotherapy management includes pain relief modalities like ultrasound, TENS etc Cyriax Method, IASTM (INSTRUMENT ASSISTED SOFT TISSUE MANIPULATION), Myofascial release of extensor carpi radiallis brevis, Strengthening exercises, Mulligan mobilisation with movement, Stretching techniques
Use of Kinesiotaping, braces, straps provides support and helps in rehabilitation phase

For further information visit

https://www.physio-pedia.com/Lateral_Epicondylitis