Definition, Diagnosis and Treatment of Carpel Tunnel Syndrome

Carpal Tunnel Syndrome (CTS)

·         Repetitive stress injury

·         Due to inflammation of the tissues around the median nerve

·         Results in reduced nerve transmission; pain, numbness, and tingling in wrist, hand, and fingers (except little finger)

Causes of CTS

Work-related

·         Repetition

·         High force

·         Awkward joint posture

·         Direct pressure

·         Vibration

·         Prolonged constrained posture

Medically-related

·         Fractures

·         Arthritis

·         Diabetes

·         Obesity

·         Acromegaly

·         Long term hemodialysis

·         Pregnancy

Symptoms

·         Pain in wrist and hand

·         Numbness and tingling in fingers

·         Weakened grip

·         Feeling of swelling in hand

·         Worsened pain at night with rest

Diagnosis

Medical History

·         Job

·         Symptoms

·         Medical conditions

Physical Exam

·         Tinel’s sign (tapping median nerve)

·         Phalen’s test (compression of nerve)

·         Muscle strength (thenar strength)

Diagnosis

Lab tests

·         X-ray

·         MRI

X-ray and MRI

·         X-ray: check for arthritis or fractured bones; not useful for detecting CTS 

·         MRI: to estimate severity of CTS: not used routinely but is capable of detecting abnormalities indicative of CTS.

Electrodiagnostic tests

·         Electromyography

·         Nerve conduction (electric shocks)

Electromyography (EMG)

·         To confirm diagnosis

·         Indwelling or surface electrodes; electrical activity is displayed on a screen (benefits vs. disadvantages)

·         Conditions such as obesity and anxiety can slow conduction speed and cause skewed results

Nerve Conduction Studies

·         Surface electrodes on hand and wrist

·         Small elec. shocks applied to nerves in fingers, wrist, and forearm (measure speed of conduction)

·         Can detect 84% of people with CTS

·         Can eliminate 95% of cases that are not CTS

Investigative Tests

·         Researchers reported on a computer-assisted device

·         Measures pinch and grip strength and finger pressure

·         Accurate and consistent way to diagnose CTS

Treatments

Conservative

·         Rest, Ice, Heat

·         Brace

·         Physical therapy

·         Drugs

·         NSAIDS  (ibuprofen naproxin, aspirin): recommended EARLY in the inflammation cycle

·         Corticosteroids: decrease in tendon strength & mass over time

       Surgery

·         Endoscopy

·         Mini Open Release

·         Percutaneous Balloon Carpal Tunnel-Plasty

       Alternative Therapies

·         Vitamins (B6)

·         Chiropractic methods

·         Acupuncture

·         Electromagnetic fields