Carpal Tunnel Syndrome Symptoms and Special Tests

Primary provider of wrist stability = Ligaments Most common cause of wrist sprains = Fall with hyperextension Treatment approach for lax ligaments = Tape reinforcement by athletes Characteristics of sprained ligaments = Lax once sprained

Area affected by DeQuervain's Tenosynovitis = Abductor pollicis longus and extensor pollicis brevis tendons Main cause of DeQuervain's Tenosynovitis = Repetitive ulnar deviation Common symptoms of DeQuervain's Tenosynovitis = Pain and swelling at radial styloid Special test for DeQuervain's Tenosynovitis diagnosis = Finklestein's Test

Initial treatment for pain and swelling reduction = Wrist and thumb immobilization, modalities Criteria to start active motion after initial treatment = Reduction in pain and swelling Focus of resistance exercise for affected area = Contractions that do not produce symptoms Additional areas addressed during treatment = Motions of wrist and forearm looking for symptomology

Post-op care resembling that of CTS = Chronic cases of DeQuervain's Tenosynovitis Indicated intervention for chronic cases = Surgical decompression if necessary Similarity in ligamentous injuries post-treatment = Wrist immobilization after injury Long-term reinforcement method for weak ligaments = Use of tape by athletes

Transverse ligament = Responsible for holding the carpal bones in place and forming the carpal tunnel Radial collateral ligament = Provides stability to the wrist on the radial side Ulnar collateral ligament = Provides stability to the wrist on the ulnar side Dorsal radiocarpal ligament = Supports the wrist dorsally

Palmar fascia = Provides protection and support to the tendons and nerves in the palm of the hand Flexor retinaculum = Forms the roof of the carpal tunnel and keeps tendons in place during wrist movements Extensor retinaculum = Helps stabilize extensor tendons on the dorsal side of the wrist Triangular fibrocartilage complex (TFCC) = Supports and cushions the wrist joint, especially the ulnar aspect

Numbness and tingling in median nerve distribution = Carpal tunnel syndrome Pain in wrist but can be muscular = Carpal tunnel syndrome Clumsiness in hand activities = Carpal tunnel syndrome Weak grip in pinch and thumb action = Carpal tunnel syndrome

Phalen's test = Pressing backs of hands together resulting in tingling after a few seconds Tinel's test = Tapping ventral wrist to stimulate tingling response in median nerve Digital Allen Test = Testing radial and digital artery by compressing arteries and evaluating circulatory recovery ASTYM Test = A better choice for carpal tunnel treatment involving scraping therapy

Splinting the affected wrist in 0-20 degrees of extension = Immobilizing the wrist in a specific range to reduce symptoms Injection of corticosteroids = Using anti-inflammatory medication to reduce swelling and pain Exercise of affected limb-primarily elbow and shoulder ROM = Improving range of motion and strength in surrounding areas to support affected wrist Immobilization 2 to 14 days which encourages improper scar tissue development = Potential risk associated with extended immobilization leading to inappropriate scar formation

Transverse ligament = Cut during decompression surgery to release pressure on median nerve Radial collateral ligament = Ulnar collateral ligament = Dorsal radiocarpal ligament =

Radial collateral ligament = Attaches to radial styloid and trapezium and scaphoid; Provides lateral support Ulnar collateral ligament = Attaches to ulnar styloid and pisiform and triquetrum; Provides medial support Palmar radiocarpal ligament = Limits wrist extension; Attaches to the anterior ulna and radius and to the anterior surface of the proximal carpals Dorsal radiocarpal ligament = Limits wrist flexion; Attaches from posterior surface of the distal radius to posterior scaphoid, lunate, and triquetrum

Palmar radiocarpal ligament = Limits wrist extension Dorsal radiocarpal ligament = Limits wrist flexion Radial collateral ligament = Provides lateral support Ulnar collateral ligament = Provides medial support

Palmar fascia (palmar aponeurosis) = Superficial triangular fascia on palm of hand; Attachment for the palmaris longus and flexor retinaculum Dorsal radiocarpal ligament = Limits wrist flexion Radial collateral ligament = Provides lateral support Ulnar collateral ligament = Provides medial support

Carpal Tunnel Syndrome (CTS) = Affects 4% of the entire US workforce; Entrapment of the median nerve within the carpal tunnel Radial collateral ligament injury = Leads to reduced lateral support Ulnar collateral ligament injury = Results in compromised medial support Palmar fascia inflammation = Causes pain on palm movement

Phalen's test = Patient holds wrists in full flexion for 60 seconds; Positive if tingling or numbness occurs in median nerve distribution Tinel's sign = Tap over median nerve at wrist crease; Positive if tingling sensation radiates into hand Finkelstein's test = Patient makes a fist with thumb inside fingers, then ulnarly deviates wrist; Positive if pain at thumb base is present Durkan's test = Pressure applied directly over carpal tunnel for 30 seconds; Positive if reproduces symptoms in median nerve distribution