Carpal Tunnel Syndrome

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Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is an entrapment neuropathy caused by compression of the median nerve as it travels through the wrist's carpal tunnel. It is the most common nerve entrapment neuropathy, accounting for 90% of all neuropathies. Early symptoms of carpal tunnel syndrome include pain, numbness, and paresthesia. Symptoms typically present, with some variability, in the thumb, index finger, middle finger, and the radial half (thumb side) of the ring finger. Pain also can radiate up the affected arm. With further progression, hand weakness, decreased fine motor coordination, clumsiness, and thenar atrophy can occur.

 

Etiology:

Carpal tunnel syndrome results from increased pressure in the carpal tunnel and subsequent compression of the median nerve. The most common causes of carpal tunnel syndrome include genetic predisposition, history of repetitive wrist movements such as typing, or machine work as well as obesity, autoimmune disorders such as rheumatoid arthritis, and pregnancy.

 

Clinical Presentation:

CTS onset is generally gradual with tingling or numbness in the median nerve distribution of the affected hand. Patients may notice aggravation of symptoms with static gripping of objects such as a phone or steering wheel but also at night or early in the morning. Many patients will report an improvement of symptoms following shaking or flicking of their hand. As the disorder progresses, the feeling of tingling or numbness may become constant and patients may complain of burning pain. The final symptoms are weakness and atrophy of muscles of the thenar eminence. These combined effects of sensory deprivation and weakness may result in a complaint of clumsiness and loss of grip and pinch strength or dropping things.

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Physical Therapy Management:

Physical therapists can give advice on modifications of activities and the workplace (ergonomic modifications), task modification, For example, taking sufficient rest and variation of movements. Often simple obvious alterations to the working practice can be beneficial in controlling milder symptoms of CTS. Manual therapy techniques include mobilization of soft tissue, carpal bones, and median nerve. Other modalities include: ultrasound and splinting.