The Carpel tunnel is an anterior compartment located at the base of the palm.
There are 9 flexor tendons and median nerve passing through this tunnel.
The tunnel is surrounded on three sides by the Carpel bones (prominence of scaphoid tubercle, Trapezium and the hamate hook) forms an arch.
It is anteriorly bordered by Transverse Carpel Ligament also known as Flexor Retinaculum.
Compression of the median nerve causes:
· Atrophy of the thenar eminence
· Weakness of the flexor pollicis brevis,opponens pollices,abductor pollices brevis
As these muscles runs deep to Transverse Carpel Ligament (TCL)
CTS Also cause sensory loss in the digits supplied by the median nerve.
Understanding Carpel Tunnel Syndrome!!
Carpel Tunnel syndrome is a medical condition occurred due to compression of the MEDIAN NERVE at the Carpel tunnel (anterior compartment at the base of palm).
Sing and Symptoms:
This syndrome consists symptoms in_
Motor changes
Sensory changes
Vasomotor changes
Trophic changes
Main sign and symptoms are:
· Pain
· Numbness
· Tingling
· Burning sensation
· Ache & discomfort
In index finger, middle finger and thumb side of the ring finger.
Ache and discomfort can be felt more proximally in forearm or even the upper arm.
Numbness and Paresthesia in the median nerve distribution are the hallmark neuropathic symptoms of C.T.S.
Discomfort is usually worst at night and in the morning.
Risk factors:
Obesity
Repetitive wrist work
Pregnancy
Genetic
Rheumatoid arthritis
Trauma
Other factor:-
o Intrinsic factor(pressure within the tunnel).
o Extrinsic factor(pressure exerted from outside the tunnel).
Diagnosis
No standard diagnosis for CTS.
A combination of described symptoms,clinical finding and electrophysiological testing may be used.
Ultrasonography is also used in the diagnosis of CTS.
Electrodiagnostic (EDX) testing for confirmation is used.
Numbness in the distribution of the median nerve,Nocturnal symptoms,thenar muscle weakness/ateophy are diagnosed.
Phalen's test
Froment's sign/book holding test
Paper holding test
Tinel sign
Prevention
Try a softer Touch
Give yourself a break
Stretch often
Watch your posture
Treatment
Physiotherapy
Splinting
Surgical release
Wrist braces
Corticosteroid injection can be effective for temporary relief from symptoms.
Physiotherapy and CTS
Physiotherapy treatment can be effective in reducing your symptoms and getting you back to performing normal activities.
Therapy program may include:_
· Education regarding_ changing wrist position (avoid prolonged bending of wrist), ‘Stretch break’during work.
· Exercise to increase strength of muscle of hand and forearm
· Stretching exercise to increase flexibility of wrist,hand,and finger
· Use of heat/cold treatment to relieve pain.
· Interrupting activities,as well as altering the right and left hand when possible at home or work.
A physiotherapist also went to your place to adjust your working area.
Applying Manual testing therapy technique including mobilization of:
Soft tissue, Carpel bone, Median nerve
The goals of physiotherapy are to reduce your symptoms without the need for surgery, to enable you to be as active and functional as possible, and to help you resume your normal work, home, and leisure activities.
Ashish Sain
BPT 1st year
College of physiotherapy
PGIMS,Rohtak
Reference
Bdc volume 1 ,edition 7
Wikipedia
webmed webiste
Image source- google
WWW.choosept.com
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