In this article, we will discuss about the Phalen’s test. So, let’s get started.
The objective is to diagnose Carpal tunnel syndrome
(1) Raise the arms to shoulder level
(2) Bring both the dorsum of the hand closer to each other (as shown in the picture below)
(3) Hold the wrist in the forced flexion position for 30-60 seconds
Positive test elicits tingling and numbness along the median nerve distribution area i.e thumb, index finger, middle finger, and lateral half of the ring finger.
The sensitivity and specificity of the Phalen test are 67.2% and 92.9% (range between 51-91% and 33-93% respectively). Therefore it should be used in adjunct with other diagnostic tool for proper screening of carpal tunnel syndrome.
Compression of median nerve in the carpal tunnel causing numbness, tingling sensation and weakness in hand.
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
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
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.
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
Brachial plexus injury
DASH (Disability of shoulder and hand questionnaire)
BCTQ (Boston Carpal tunnel questionnaire)
MHQ (Michigan Hand Outcome questionnaire)
PEM (Patient Evaluation Measures)
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