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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