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
PHYSICAL EXAMINATION AND DIAGNOSIS
Following Physical examination tests are performed to evaluate carpal tunnel syndrome.
Tinel’s Sign
Phalen’s test
Reverse Phalen Test
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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https://www.physio-pedia.com/Carpal_Tunnel_Syndrome
https://www.physiocheck.co.uk/condition/46/carpal-tunnel-syndrome