Carpel Tunnel Syndrome

It is pain, numbness, burning and tingling sensation in one’s hands and fingers and if left untreated can cause long term weakness and nerve damage to the hand.

• It is caused by compression (pressure put on and/or pressing) of the median nerve at the wrist as it passes through the carpal tunnel.
• The carpel tunnel is a tunnel that runs down from the wrist into the palms of one’s hand.
• It also contains the median nerve which controls sensation and movements of fingers.
• The nerves are protected by the lubricating membrane/wall, the synovium.
• If there is fluid in build up in the tunnel and/or synovium and/or when the wrist and fingers are bent, this increases pressure in the tunnel.
• Due to lack of space the median nerve is pressed against the tunnel causing pain, numbness, burning and tingling sensation in one’s hands and fingers.

Diagnosis test

• Please click for ‘Physiotutors’ diagnosis tests.

Consider:

Phalen’s test

• Flexing the wrist for 60 seconds produces pain or paraesthesia in the median nerve distribution in CTS.
• This test is typically performed either with the patient flexing their own wrists by placing the backs of the hands together or by the clinician passively flexing the patient’s wrist (see Figure 4)​[33]​.

IMAGES COURTESY OF PATERSON AND PINEDO

Tinel’s test

• Tapping repeatedly over the median nerve at the wrist produces pain or paraesthesia (reflect a perception of abnormal sensation, including feelings of pins and needles, tingling, pricking or a feeling as if ants are crawling over/under the skin) in the median nerve distribution in Carpel Tunnel Syndrome.

Kuschner S, Ebramzadeh E, Johnson D, et al. Tinel’s sign and Phalen’s test in carpal tunnel syndrome. Orthopedics 1992;15:1297–302.
https://www.ncbi.nlm.nih.gov/pubmed
/1461811

IMAGES COURTESY OF PATERSON AND PINEDO

Durkan’s test (carpal tunnel compression test)

• Also known as the carpal tunnel compression test, pressure is applied over the proximal edge of the carpal ligament (the proximal wrist crease), which produces or worsens paraesthesia (reflect a perception of abnormal sensation, including feelings of pins and needles, tingling, pricking or a feeling as if ants are crawling over/under the skin) in the median nerve distribution in Carpel Tunnel Syndrome.

Durkan J. A new diagnostic test for carpal tunnel syndrome. J Bone Joint Surg Am 1991;73:535–8.

Figure 6: Durkan’s test

IMAGES PRODUCED COURTESY OF PATERSON AND PINEDO

By Mark Hanson, Ben Charmer, Joshua Pinedo & Alastair Paterson

The Pharmaceutical Journal, PJ, October 2021, Vol 307, No 7954;307(7954)::
DOI:10.1211/PJ.2021.1.106307

• Ones hand and wrist may feel worse than they used to feel, but the pain should start to go away.
• It usually takes 3 to 4 months to recover and up to 1 year before hand strength returns.
• How much strength returns will vary.

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