Carpal Tunnel Syndrome Quiz

Wrist Joint - Carpal Tunnel Syndrome

• Carpal Tunnel Syndrome is the most common peripheral neuropathy
• Women are twice as likely to be affected as men
• CTS typically develops in middle and older adulthood (>40 years)

Causes of Carpal Tunnel Syndrome

• Prolonged wrist flexion/extension (e.g., sleeping positions)
• Conditions affecting fluid balance (e.g., pregnancy, dialysis)
• Trauma (e.g., wrist fracture)
• Arthritis
• Exposure to vibrating machinery

Symptoms of Carpal Tunnel Syndrome

• Paresthesia (e.g., numbness, tingling) in the median nerve distribution
• Nocturnal pain is common
• Activities like driving or holding objects can aggravate pain
• Pain is often relieved by hand massage or shaking

Special Tests for Carpal Tunnel Syndrome

• Phalen maneuver
• Compression test
• Tinel sign

Differential Diagnoses

• Pronator teres syndrome
• Cervical spine issues (e.g., myotomes, dermatomes, reflexes)
• Thoracic outlet syndrome

Degrees of Carpal Tunnel Syndrome

• Dynamic: Asymptomatic, no physical findings
• Mild: Intermittent symptoms, decreased light touch sensitivity; compression test usually positive, Tinel and Phalen tests may or may not be present
• Moderate: Frequent symptoms; positive Phalen maneuver, compression test and Tinel sign; decreased vibratory perception in the median nerve distribution; increased two-point discrimination; weakness of thenar muscles
• Severe: Persistent symptoms; increased or absent two-point discrimination; atrophy of thenar muscles

Conservative Management

• Activity modification
• Neutral wrist splint (more effective for less severe cases)
• Stretching
• Tendon gliding exercises

Surgical Management

• Indications: Thenar eminence atrophy, weakness, sensation loss; symptoms lasting >1 year despite conservative treatment
• Goals: Decompress the nerve, improve nerve excursion, prevent progressive nerve damage

Surgical Techniques

• Carpal bone mobilization
• Ultrasound
• NSAIDs
• Cortisone injection (not into the median nerve)
• Control of systemic diseases (e.g., diabetes, rheumatoid arthritis, RA)
• Open carpal tunnel release (preferred over endoscopic due to fewer complications) Increased frequency of digital nerve laceration Increased incidence of incomplete release

Post-Surgical Complications

• Pillar pain (25%): resolves within 3 months in most patients
• Incomplete release of the flexor retinaculum with persistent CTS (common after endoscopy)
• Recurrence of CTS: 7% - 20% of patients

Rehabilitation After Open CTS Release

• Encourage gentle range of motion (ROM) exercises from the first post-surgical day, possibly with a wrist splint
• Allow use of the hand in activities of daily living (ADLs) as tolerated after dressing removal (~2 weeks)
• Begin range of motion and strengthening exercises after suture removal
• Scar management
• Gradually return to work or activities as tolerated

De Quervain's Tenosynovitis

• Inflammation of tendons along the thumb side of the wrist (abductor pollicis longus and extensor pollicis brevis)
• Symptoms: Pain and swelling near the base of the thumb, difficulty moving the thumb/wrist (especially during grasping/pinching), localized swelling over the radial styloid

De Quervain's Tenosynovitis Diagnosis

• Diagnosis usually based on history and physical exam (swelling and tenderness, grating sensation when moving thumb)
• Finkelstein's test

De Quervain's Tenosynovitis Treatment

• Non-invasive methods: ice application, dorsal hood splint/thumb spica splint
• Steroid injections (most effective; up to 2, spaced 6 weeks apart)
• Surgery (usually reserved for cases > 1 year with conservative management failure)
• Physical therapy

Wrist Sprain

• Injury to ligaments supporting the wrist
• Gradual or sudden forceful wrist action
• Diagnosis of exclusion (rule out fractures or strains)
• Grades:
  • Grade I (Mild): Stretched ligaments
  • Grade II (Moderate): Partial tear of ligaments
  • Grade III (Severe): Complete tear of ligaments, joint instability

Wrist Sprain Diagnosis

• History and physical exam
• X-rays

Wrist Sprain Treatment

• Rest: Avoid pain-inducing activities
• Ice: 15-20 minutes, 2-3 hours, for initial 48 hours
• Compression: Bandage to reduce swelling (not overly tight)
• Elevation: Keep elevated while resting and sleeping
• Immobilization (splint or brace)
• Pain medication (over-the-counter)
• Physical therapy for a gradual return to activities

Baseball Finger (Mallet Finger)

• Rupture of the extensor tendon in the distal interphalangeal (DIP) joint
• Caused by sudden passive flexion of the extended DIP joint
• Usually occurs during a forceful jamming of the finger while catching a ball
• Symptoms: DIP joint flexes and cannot be extended actively

Baseball Finger (Mallet Finger) Treatment

• Conservative: Splinting
  • DIP joint in extension
  • Usually 6-8 weeks
  • Frequent position checks to prevent contractures
  • Gentle active flexion and nightly splinting from week 2
  • Surgery (if healing poor or tendon fragment)
• Rehabilitation phase: gradual increase of resistance and intensity of exercises; functional activities; sport-specific training; home exercise program; education

Return to Play

• For all conditions, activity can resume once splint is worn and pain is controlled