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carpal tunnel syndrome

Hand Anatomy

The Carpal tunnel is a canal formed by bone and ligamentus borders at the wrist, through which

the nine-flexor tendons

  • 4 flexor digitorum profundus
  • 4 flexor digitorum superficialis
  • and the flexor pollicis longus
  • the median nerve pass.

The floor of this tunnel is an arch formed by the carpal bones, the top of the tunnel is known as the flexor retinaculum, or the transverse carpal ligament.

Radially, this ligament attaches on the scaphoid tuberosity and the trapezium, and to the pisiform and the hook of the hamate on the ulnar side.

In a healthy tunnel, the synovial sheeths surrounding the tendons act as protective padding for the median nerve as it travels through the canal.

However, as the demands of the tendons increase with activities of daily living, this protective cushion can become more fibrous in nature, which made lead to entrapment, and or crushing of the median nerve.

More than 30 individual muscles in the hand and forearm work together to achieve the diverse movements. These muscles provide the hands with unsurpassed flexibility, extremely precise control, and gripping strength that are necessary for activities ranging from writing and typing to sew and gripping a ball in sports.

Hand Function

We explore the world through our hands, the tactile information arriving at our brain plays an essential role in the ongoing motor behavior.

The National Institute of Neurological Disorders and Stroke (USA) indicates that carpal tunnel syndrome is "often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself"

What is CTS

The carpal tunnel is a narrow passageway on the palm side of your wrist made up of bones and ligaments. The median nerve, which controls sensation and movement in the thumb and first three fingers, runs through this passageway along with tendons to the fingers and thumb. When it's pinched or compressed, the result is numbness, tingling, weakness, or pain in the hand, called carpal tunnel syndrome.

It is the most common entrapment neuropathy, with repetitive, forceful angular hand movements or vibration placing persons at risk for the condition.

Treatment

Surgical

Endoscopic surgery.

Non Surgical

With OT

  • Your surgeon uses a telescope-like device with a tiny camera attached to it (endoscope) to see inside your carpal tunnel. Your surgeon cuts the ligament through one or two small incisions in your hand or wrist.
  • Endoscopic surgery may result in less pain than does open surgery in the first few days or weeks after surgery.

Open surgery.

  • Your surgeon makes an incision in the palm of your hand over the carpal tunnel and cuts through the ligament to free the nerve.

Surgical

By: Shahd AL-Shaer

Any Questions

Causes...

Symptoms...

Repetitive maneuvers

1- Pain

2- Aching

3- Tingling

4- Numbness

5- Your hand may feel weak, or your fingers numb, or both.

6- You may find that you drop things more often and that activities which require fine finger movements, like writing or fastening buttons, become more difficult.

These symptoms occur in the thumb and the two fingers next to it, as well as half of the ring finger. They may extend to the rest of the hand and into the forearm.

Work stress

Repeated use of vibrating hand tools

Pregnancy

Scar Management :

Scar massage;

Adhesive tapes

Silicone gel sheet

You may not notice the problem at all during the day, though certain activities,such as; writing, typing,or housework.

Inflammatory, degenerative, and rheumatoid arthritis

Diagnosis ...

Diabetes

Tinel’s sign at the wrist

The symptoms tend to be worse at night and may disturb your sleep.

Hypothyroidism, or an under active thyroid

Home exercises

Trauma or lesions , such as dislocation or fracture of the wrist

Phalen’s test

Revers Phalen's test

A cyst or tumor in the carpal tunnel

An overactive pituitary gland

Any kind of swelling or inflammation around the tendons

Carpal compression test

Who is at risk of developing carpal tunnel syndrome?

Related To Job :

Women are three times more likely to have carpal tunnel syndrome than men.

Carpal tunnel syndrome is most frequently diagnosed between the ages of 30 and 60.

The dominant hand is usually affected first and produces the most severe symptoms.

Cashiers

Hairdresser

Knitters or sewers

Bakers

Dentists

Locksmith

Computer use

VISIT ONE:

1- Standard evaluation.

Look For: Positive Phalen’s and positive Tinel’s.

2- Evaluation of work habits and avocational activities.

3- Fabrication of wrist splint in neutral with instruction to wear at night. (Cock up splint)

or we can use knesiology taping for carpal tunnel syndrom

4- Issue and review educational materials regarding postures and work habits to avoid and proper hand use.

5- Home exercise program with stretches and tendon glides as well as use of ice.

VISIT TWO (7-10 DAYS AFTER VISIT ONE):

1- Re-evaluation of signs and symptoms for improvement.

2- Have patient demonstrate home exercise program to ensure independence.

3- Have patient state how he/she has changed his/her work and/or lifestyle habits to improve hand use.

VISIT ONE:

1- Evaluation excluding strength testing.

2- Instruction in scar massage and scar management.

3- Home exercise program with active range of motion and tendon glides.

4- Educate patient in proper hand use at home and work. Patient given handouts on ergonomically correct postures for home and work.

VISITS 2-6: (1-2 times per week as appropriate for patient)

1- Discharge when patient meets discharge criteria, even if visit two.

2- Scar massage.

3- Review home exercise program and have patient demonstrate exercises.

4- Issue theraputty and instruct patient in exercises.

5- Continued therapy based upon the need to manage scar or ensure follow through of home exercise program for successful outcome.

NOTE: Grip can be measured with a dynamometer one month after surgery

Reference

• http://www.innerbody.com/image_skel13/ligm27.html

• https://www.healthline.com/human-body-maps/hand-muscles#1

• Gibson, J.J. (1962). Observations on active touch. Psychological Review, 69, 477–491

• https://link.springer.com/chapter/10.1007/978-94-015-8285-8_17

• https://www.medicinenet.com/carpal_tunnel_syndrome_pictures_slideshow/article.htm

• https://www.arthritisresearchuk.org/arthritis-information/conditions/carpal-tunnel-syndrome/symptoms.aspx

• https://www.ccohs.ca/oshanswers/diseases/carpal.html

• https://www.healthline.com/health/carpal-tunnel-syndrome#riskfactors

• https://www.medicalnewstoday.com/articles/184337.php

• Pendleton, H., & Schultz-Krohn, W. Pedretti's Occupational Therapy - E-Book.

• https://www.ouh.nhs.uk/patient-guide/leaflets/files/5022Pcarpal.pdf

• https://www.brighamandwomens.org/assets/BWH/patients-and-families/rehabilitation-services/pdfs/wrist-carpal-tunnel-syndrome-ot.pdf

• http://www.sosmed.org/protocols/ot-protocols/CTS.pdf

• https://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/diagnosis-treatment/drc-20355608

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