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Dr. Monsur Rahman, profile picture
Uploaded byDr. Monsur Rahman
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Carpal tunnel syndrom

Carpal tunnel syndrome (CTS) arises from entrapment of the median nerve within a confined space formed by carpal bones and the transverse carpal ligament, leading to symptoms such as numbness, tingling, and pain. Causes can be acute, like trauma, or chronic due to repetitive wrist motions, with patients presenting specific signs such as nocturnal pain and weakness in grip strength. Treatment options include non-operative methods like splinting and cortisone injections, as well as surgical intervention for severe cases.

Health & Medicineâ—¦
Presented By: MD. MONSUR RAHMAN MPT (Musculoskeletal Disorders) MM UNIVERSITY, MULLANA, AMBALA Carpal tunnel syndrome
Carpal tunnel ď‚— The carpal tunnel is formed between the carpal bones of the wrist and the transverse carpal ligament. ď‚— The ligament is an unyielding thick fibrous tissue which does not allow for changes in volume within the carpal tunnel.
Carpal tunnel syndrome ď‚— Carpal tunnel syndrome(CTS) is a collection of symptoms and signs that occurs following entrapment of the median nerve within the carpal tunnel. ď‚— Usual symptoms include numbness, parasthesia and pain in the median nerve distribution. ď‚— This symptoms may or may not be accompanied by objective changes in sensation and strength of median-innervated structures in the hand.
Anatomy The carpal tunnel is an osteofibrous canal located in the volar wrist. The boundaries are the carpal bones forming the floor and the flexor retinaculum(transverse carpal ligament) forming the roof.
The retinaculum is about 3-4 cm wide and inserts into the scaphoid tubersity and into the pisiform(proximal carpal tunnel) and subsequently into the trapezium and the hook of the hammet(distal carpal tunnel) On the radial side it divides into two layers, a superfacial layer and a deep layer to accommodate the tendon of the flexor carpi radialis.
ď‚— The carpal tunnel contains nine tendon and a nerve the flexor policis longus ,the four flexor digitorum superficialis, the four flexor digitorum profundus as well as median nerve. ď‚— The flexor carpi radialis tendon inserts into the scapoid and into the second metacarpal bone after passing through the cannal formed by the splitting of the flexor reticulum. ď‚— The flexor carpi ulnaris tendon inserts into the pisiform, whereas the palmaries longus tendon continues with the palmar fascia or inserts into the flexor retinaculum.
Pathophysiology The tendon of the hands are wrapped with a lining that produce a synovium fluid which lubricates the tendons. With repetitive movement of the hand the lubrication system may malfunction. This reduction in lubrication results in inflammation and swelling of the tendon area Abnormality high carpal tunnel pressures exit in patients with CTS. This pressure causes obstruction to venous outflow, back pressure, edema formation and ultimately ischemia in the nerve.
Etiology Acute etiology ď‚— Sudden trauma ď‚— Wrist fracture ď‚— Crush injury ď‚— Burns Chronic Etiology ď‚— Conservative cast Occupational Etiology ď‚— Repetitive wrist flexion/ extension ď‚— Intense Greeping ď‚— Computer keyboards
Sign and symptoms ď‚— Paresthesia, Pain and Numbness in the palmar surface of the hand. ď‚— Nocturnal pain ď‚— ADL causes increase the symptoms ď‚— Arching in the thumb ď‚— Clumsiness in hand ď‚— Change in touch or temperature sensation ď‚— Pain from the wrist to the fingers Swelling of hand and forearm ď‚— Weakness of grip ability to pinch and other thumb actions
Work related ď‚— Tailor,sewer ď‚— Gardener ď‚— Home maker ď‚— Painter ď‚— Locksmith ď‚— Typing
Non work related ď‚— Arthritis ď‚— Diabetes ď‚— Thyroid gland imbalance Broken or dislocated bones of the wrist ď‚— Hormonal changes associated with menopause ď‚— Pregnancy
Nerve Motor loss Sensory loss Functional loss Median nerve (C6-C8,T1) Flexor pollicis brevis,Abductor pollicis brevis,opponensp olicis ,lateral two lubricals Palmar and dorsal thumb,index, and middle and lateral half of ring finger. Thumb opposition Thumb flexion Weak grip
Provocative testing maneuvers ď‚— Phalen Maneuver ď‚— Tinel Sign ď‚— Carpal compression test
Differential diagnosis ď‚— Thoracic outlet syndrome ď‚— -Adson test ď‚— Roos test ď‚ž Cervical rediculopathy ď‚ž Spurling test
Treatment ď‚— Non Operative ď‚— Splint ď‚— Activity modification ď‚— Cortisone Injection ď‚— NSAIDs ď‚ž Operative ď‚ž Open carpal tunnel release
Rehabilitation protocol O-7days Gentle wrist flexion and extension exercise ď‚— Full finger flexion and extention exercise 7 days ď‚— Removeve the dressing ď‚— Discontinue the wrist splint if the patient feel uncomfortable 7-14 days ď‚— permit the patient to use the hand in activities of daily leaving as pain allow. 2 weeks ď‚— Control pain by electrical stimulation. ď‚— Remove the suture and begin strenthening exercises
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