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The Carpal tunnel is a canal formed by bone and ligamentus borders at the wrist, through which
the nine-flexor tendons
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.
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"
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.
Surgical
Endoscopic surgery.
Non Surgical
With OT
Open surgery.
Surgical
By: Shahd AL-Shaer
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
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
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
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.
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.
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.
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
• 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