Carpal Tunnel Syndrome

DEFINITION

Abnormal involvement of the median nerve due to anything that increases the volume of the structures within this tunnel, or any condition that narrows the tunnel itself.

MECHANISM OF INJURY

The carpal tunnel may be narrowed by local trauma, bone deformity following fracture, osteoarthritis, synovial swelling of tendon or wrist joint, and thickening of the transverse ligament.  Often, no local cause for median nerve compression can be detected.  The syndrome may be produced by radial and ulna arterial impairment since they also pass beneath the transverse carpal ligament.

SYMPTOMS

Numbness, and pain which follows the course of the median nerve distribution.

SIGNS

Early swelling at the wrist and later sensation impairment of the thumb, forefinger, middle finger, and the medial one-half of the ring finger.  Muscle atrophy may be present.  Extreme extension/flexion may reproduce or intensify symptoms.

PHALEN’S TEST

Procedure:  The patient puts the backs of both hands together and holds the wrists in forced flexion 1 minute.

Positives:  Numbness and tingling along the median nerve distribution in the hand.

Indicates:  Median nerve entrapment.

(Carpel Tunnel Syndrome – Fingers 1, 2, 3)

X-RAY

Paralunar dislocation and fracture of the scaphoid are frequently found in cases of trauma.

DYSKINETIC MUSCLES

Muscles of the wrist.

TREATMENT

• Manipulation of distal radius/ulna and involved carpal bones.
• Elimination of any irritating activity.
• Daily ice sessions (20 minutes), followed by active range of motion.
• Therapy modalities.