Carpal Tunnel Syndrome

• Carpal Tunnel Syndrome:

  • compression of the median nerve in the carpal tunnel beneath the flexor retinaculum
  • symptoms:
  • Paraesthesia (as shown)
  • Pain (as shown)
  • Weakness – thenar eminence
  • Reduced dexterity
  • symptoms usually have a nocturnal pattern

  
• Carpal Tunnel Syndrome:

  • Causes/contributing factors:
  • often idiopathic
  • OA/RA
  • obesity
  • pregnancy
  • hypothyroidism
  • congenital abnormalities
  • trauma e.g. radius fractures
  • overuse of finger flexors potentially
  • Assessment:
  • Test muscles of thenar eminence
  • Tinels/Phalens  tests (limited sensitivity and specificity)
  • Neural Provocation Tests – ULPT 1a
  • Wrist – ROM, strength, accessories
  • Investigations – EMG, ultrasound, MRI
• Carpal Tunnel Syndrome - Management:

  • Address ergonomics – wrist position, posture, gripping activities
  • Address neurodynamic issues
  • Splinting – neutral position
  • Mobilisation of radiocarpal joint (if stiff)
  • Strengthen muscles if affected (thenar eminence)
  • Avoid overworking lumbricals and finger flexors
  • NSAIDS
  • Corticosteroid injection
  • Surgery
• Carpal Tunnel Syndrome:

  • compression of the median nerve in the carpal tunnel beneath the flexor retinaculum
  • neural symptoms, especially in the 1st three and a half fingers