Carpal Tunnel Syndrome Quiz

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Questions and Answers

What is the primary focus of a treatment protocol for a wrist sprain?

Minimizing strain and promoting healing (correct)

Only using pain medications as needed

Initiating extensive physical therapy immediately

Quickly restoring full mobility without restrictions

Which of the following symptoms is associated with de Quervain’s tenosynovitis?

Pain only during rest

Lack of any swelling

Numbness in the little finger

Localized swelling over the radial styloid (correct)

What is the recommended duration for applying ice to the affected area of a wrist sprain?

One hour every day for a week

30 minutes every hour

15-20 minutes every 2-3 hours (correct)

Only when swelling is severe

Why is it important to monitor blood circulation when applying a compression bandage?

To avoid impedance of blood circulation Signup and view all the answers

What is the role of physical therapy in the treatment protocol for hand injuries?

To improve strength, flexibility, and range of motion after recovery Signup and view all the answers

Which tendons are primarily affected by de Quervain’s tenosynovitis?

Abductor pollicis longus and extensor pollicis brevis Signup and view all the answers

What approach should be taken when returning to work and daily activities after a wrist injury?

Gradually reintroducing activities while avoiding strain Signup and view all the answers

What is the significance of immobilization in the treatment process for wrist injuries?

It prevents further injury and facilitates healing Signup and view all the answers

What type of medication is commonly recommended for managing pain and inflammation in wrist injuries?

Acetaminophen and NSAIDs Signup and view all the answers

What is a primary cause of Carpal Tunnel Syndrome?

Prolonged wrist flexion or extension during sleep Signup and view all the answers

Which gender is more frequently affected by Carpal Tunnel Syndrome?

Women Signup and view all the answers

What symptom is commonly associated with Carpal Tunnel Syndrome?

Paresthesia in median nerve distribution Signup and view all the answers

In which age group is Carpal Tunnel Syndrome most likely to occur?

Over 40 years old Signup and view all the answers

Which test is NOT used for diagnosing Carpal Tunnel Syndrome?

Straight leg raise test Signup and view all the answers

Which condition is often ruled out when diagnosing Carpal Tunnel Syndrome?

Pronator teres syndrome Signup and view all the answers

What does the compression test evaluate in relation to Carpal Tunnel Syndrome?

Median nerve compression Signup and view all the answers

Which degree of Carpal Tunnel Syndrome includes symptoms that are frequently present?

Moderate Signup and view all the answers

Which of the following is NOT considered a treatment for alleviating pain from Carpal Tunnel Syndrome?

Intensive physical therapy Signup and view all the answers

What effect does pregnancy have on Carpal Tunnel Syndrome?

It alters fluid balance and can exacerbate symptoms Signup and view all the answers

Which symptom is indicative of severe carpal tunnel syndrome?

Atrophy of the thenar muscles Signup and view all the answers

What is a common non-surgical treatment for carpal tunnel syndrome?

Resting wrist splint in a neutral position Signup and view all the answers

Which goal of surgical management for carpal tunnel syndrome aims to prevent nerve damage?

Prevent progressive nerve damage Signup and view all the answers

After open carpal tunnel release, what is recommended from day 1?

Gentle range of motion exercises Signup and view all the answers

What is a potential complication after carpal tunnel release?

Pillar pain Signup and view all the answers

Which statement correctly describes the management of systemic diseases in relation to carpal tunnel syndrome?

They should be controlled, e.g., diabetes Signup and view all the answers

Which surgical approach is preferred due to fewer complications?

Open carpal tunnel release Signup and view all the answers

What is a sign of incomplete release of the flexor retinaculum?

Persistent carpal tunnel syndrome Signup and view all the answers

Which management strategy is NOT typically involved after the removal of surgical dressing?

Engaging in aggressive physical therapy Signup and view all the answers

What percentage of patients may experience recurrence of carpal tunnel syndrome after treatment?

7% - 20% Signup and view all the answers

Study Notes

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

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Description

Test your knowledge on Carpal Tunnel Syndrome, including its causes, symptoms, and diagnostic tests. Determine how well you understand this common peripheral neuropathy that affects many individuals, especially women over 40. This quiz also covers differential diagnoses, providing a comprehensive overview of the condition.