CARPAL TUNNEL SYNDROME.
DEFINITON
– Carpal tunnel is a over crowded fibro-osseous canal formed by the 3 carpal bones like scaphoid , trapezoid , hamate and transverse carpal ligament.
– Synovitis of tendon can put pressure on the nerve.
– It is a condition in which the median nerve gets compressed as it passes beneath the flexor retinaculum.
• Causes Of carpal tunnel syndrome
– Inflammatory : Rheumatoid arthritis
– Metabolic causes : gout
– Endocrine : hypothyroidism , diabetes mellitus , pregnancy , menopause etc
– malunion of colles fracture
– Gaglion in carpal region
– OA of carpal bones
• Clinical features of carpal tunnel syndrome
– Stage 1 : Pain , discomfort in hand but is not localized to median nerve, history of morning stiffness is present in hand.
– Stage 2 : Tingling and numbness , pain and parasthesia etc. are localized to the area supplied by median nerve.
– Stage 3 : Hand clumsiness and digital function impairment.
– Stage 4 : Sensory loss in median nerve distribution along with wasting of Thenar eminence.
– Burning, aching and warmth.
– Vasomotor symptoms like cold , dry, and shiny skin
– Battle sign : Thumb and index finger contact is poor.
– loss of true opposition.
• Clinical test
(1) Phalen’s test
– Holding a wrist in flexion against each other
– Appearance of symptoms within 1 min of hold indicates Positive sign.
(2) Modified Phalen’s test
(3) Reverse Phalen’s test
– Wrist is held in extension against each other
– Appearance of sensory symptoms within one min indicates Positive sign
(4) Torniquet sign
– Arm cuff of BP instrument is inflated beyond the level of systolic blood pressure of an individual
– If there is appearence of symptoms in median nerve distribution indicates Positive sign.
(5) Bilateral arm percussion test
(6) Vibratory test
(7) Two point discrimination test
• Treatment
(1) Conservative
– Initial stage , NSAID’s is given.
– Carpal tunnel splints is used.
– Pain free relaxed passive movements or speedy active movements can be given
– Cryotherapy, TENS , Ultrasound over the palmar aspect of wrist is given.
(2) Injection treatment
– Indicated for patients with intermittent symptoms , complaint duration less than 1 year and if there is no sensory deficits.
– Single infusion of cortisone and the splints for 3 weeks .
(3) Surgery
– Division of flexor retinaculum and transverse carpal ligaments if the conservative treatment fails, any Thenar atrophy, and sensory loss.
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