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Carpal Tunnel Syndrome

WHAT IS CARPAL TUNNEL SYNDROME?

Carpal tunnel syndrome occurs when the median nerve which runs from the forearm into the hand becomes pressed or squeezed at the wrist. This results in pain, weakness, or numbness in the hand and wrist, radiating up the arm.

HOW IS CARPAL TUNNEL SYNDROME DIAGNOSED?

A physical examination help determine […]

Tinel’s test = percussion of the carpal tunnel

Significance.

This is a percussion test for the median nerve in the carpal tunnel or for the ulnar nerve in Guyon’s tunnel. It should elicit paraesthesia in the territory either of the medjan nerve – 3l-> fingers medially and palmar, or of the ulnar nerve – 1 1> ulnar fingers.

Positioning.

The subject presents […]

SPECIFIC TESTS Phalen’s test = forced flexion of the wrist

Significance.

This is a compression test for the median nerve in the carpal tunnel. Release of the pressure causes paraesthesia in the territory of the median nerve – 3l-> fingers medially and palmar.

Positioning.

The subject presents the hand.The examiner grasps the distal forearm with the contralateral hand. With the other hand he takes hold […]

Resisted abduction

Procedure.

Resist the subject’s attempt to abduct the thumb

Common mistakes.

Resistance is given on the distal phalanx.

Anatomical structures tested:

Muscle function: • Abductor pollicis longus • Abductor pollicis brevis • Extensor pollids brevis • (Flexor pollicis brevis).

Common pathological situations:

• Pain is the result of a tendinous lesion of the abductor pollicis […]

Muscles controlling the thumb

Remarks

The positioning of the subject is the same for the four tests. So is the positioning of the examiner,

Common mistakes.

The thumb is allowed to hyperextend at the metacarpophalangeal joint.

Anatomical structures tested:

Muscle function:

• Importallt thumb flexors: – Flexor pollicis longus – Flexor pollicis brevis • Less important thllmb flexor: […]

The carpal tunnel

The carpal tunnel lies between

– on the ulnar side – the pisiform bone and the hook of the hamate bone and – on the radial side – the tubercle of the scaphoid bone and the trapezium bone.

It can be localized on the heel of the hand and somewhat towards the ulnar side. It […]

Palpation of soft tissue

Palpation of the biceps muscle and the neurovascular structures in the cubital fossa Keep the subject’s elbow slightly flexed. Ask for an active flexion and palpate meanwhile in the cubital fossa with a pinching grip. Feel for the bicipital tendon as an outstanding taut structure. It runs distally to attach to the radial tuberosity. Medial […]

Carpal Tunnel Syndrome

Carpal tunnel syndrome is most often caused by overuse of the wrist, which in turn causes narrowing and inflammation of the tunnel that houses the nerves and tendons that lead from the forearm to the wrist. Compression of the median nerve causes the symptoms. Overuse is common in hand-intensive activities, particularly when the wrist is […]

Entrapment of the Median Nerve (Pronator Teres Syndrome)

The median nerve runs in front of the elbow joint and past the pronator muscle. Entrapment of this nerve is a rare condition in sport.

Symptoms and diagnosis

– Pain and tenderness occur in the middle anterior aspect of the elbow. – Numbness is felt in the second and third fingers, and in the radial […]

Carpal Tunnel Syndrome

SYMPTOMS

There is paraesthesia of the radial three and a half fingers and pain around the wrist. Often, sleep is disturbed.

AETIOLOGY

These symptoms are caused by chronic compression of the median nerve in the carpal tunnel by a hypertrophied flexor tendon retinaculum.

CLINICAL FINDINGS

There is tenderness on palpation over the carpal […]