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21 Cards in this Set
- Front
- Back
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What do the carpal bones make in the carpal tunnel?
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Tunnel Floor + Walls
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What does the Flexor Retinaculum make in the carpal tunnel?
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The roof
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What is the most common micro repatitive trauma injury?
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carpal tunnel
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Are sensory muscles deep or superficial
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superficial
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What is the ration of femals to males in developing carpal tunnel?
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3:1
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What is the definition of carpal tunnel?
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Median nerve compression at the carpal tunnel associated with numbness, and pain in the arm and hand.
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What are predisposing factors for CTS?
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Overuse or repetitive motions
Vibratory tools Awkward wrist positions Systemic conditions Diabetes Thyroid disease Arthritis Pregnancy External compression Trauma Motor vehicle accidents |
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What are the classical symptoms of CTS?
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Intermittent tingling with nocturnal arm/hand pain in thumb, index, and middle fingers
Thenar atrophy (muscle wasting) with loss of thumb dexterity Proximal arm/shoulder pain Frequently bilateral with greater severity in the dominant hand |
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What are the findings from the physical examination for CTS?
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Positive Tinel’s sign over median nerve in the carpal tunnel
Positive Phalen’s test Decreased range of motion in the wrist Sensory changes Decrease in fine touch and vibratory sensation Motor weakness Thenar atrophy (muscle wasting) |
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What is the differential diagnosis for CTS?
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Cervical (C5-C8) radiculopathy
Impingement of nerve roots in the neck Double crush syndrome Carpal tunnel syndrome- plus thoracic outlet syndrome Arthritis Peripheral neuropathy-Diabetes Multiple sclerosis |
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What is the treatment for CTS?
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OMT
Myofascial release Wrist braces Cock up splints NSAIDs Vitamin B6 supplementation 100 mg per day |
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How is CTS diagnosed?
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EMG (electromyogram) / NCS (nerve conduction studies)
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What is treatment for CTS less conservative?
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Altered activities
Activities of daily living Job modifications Home exercises Steroids (i.e. iontophoresis) Surgical decompression of carpal tunnel if conservative measures fail. |
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OMT of the wrist does what?
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Myofascial release of transverse carpal ligament Opens or dilates the carpal tunnel
Myofascial release of carpal tunnel Abductor pollicis brevis muscle Opponens pollicus muscle Stretch carpal tunnel Flexor tendons during wrist extension Home exercises Self stretching maneuvers |
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What are the three phases of the OMT Carpal tunnel release?
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Phase 1 - release of transverse carpal ligament
Phase 2 - Opponens roll Phase 3 - wrist extension to pull flexor tendons into carpal tunnel |
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With self stretching for CTS do symptoms immediatly resolved?
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No, they will get worse before they get better
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What is double crush syndrome?
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Simultaneous appearance of:
Carpal tunnel syndrome Thoracic outlet syndrome |
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Describe Double crush?
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Compression of a nerve at one point renders it more susceptible to damage at another site.
Altered function is greater than the sum of the impairment caused by individual lesions. (1+1=3) |
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What is the etiology of double crush?
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Same as carpal tunnel syndrome
Nerve compression Underlying susceptibilities ---Diabetes ---Other metabolic disorders Interruption of lymphatic or venous drainage from a proximal site Edema proximally affecting circulation to nerve Connective tissue abnormality |
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What is the surgical outcome for double crush?
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Median nerve double crush syndrome has a poorer surgical prognosis than either isolated syndrome.
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What is the osteopathic approach to treating CTS?
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If structure is normalized, function will normalize The body functions as a unit
The whole patient must be treated; not just the wrist. Once the stage is set, the body has the inherent capacity to heal itself. |
