Carpal Tunnel Syndrome and Its Physiotherapy Assessment and Management
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Course
Canadian physiotherapy license
Institution
Canadian Physiotherapy License
Book
Management of Common Musculoskeletal Disorders
Carpal Tunnel Syndrome and Physiotherapy Assessment and Mangement.
Content include,
Definition of Carpal Tunnel Syndrome (CTS)
Causes of CTS
Medical Risk Factors of CTS
Physical therapy assessment of carpal tunnel syndrome
Subjective assessment
Objective assessment
Special test
Functional ...
physiotherapy assessment of carpal tunnel syndrome
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Canadian physiotherapy license
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Carpal Tunnel Syndrome
• Definition of Carpal Tunnel Syndrome (CTS)
o Carpal Tunnel Syndrome (CTS) is a type of neuropathy that results from pressure on the
median nerve, causing sensorimotor disturbances that can negatively impact functional
abilities.
o It is also known as repetitive stress syndrome.
o Carpal Tunnel – Space between carpal bones dorsally and transverse carpal ligament
volarly. Medial nerve is susceptible to compress along with extrinsic finger flexor
tendon in this tunnel.
• Causes
o Anything that decreases the space in carpal tunnel
o Anything that causes the content of the tunnel to enlarge which could either compress
or restrict the mobility of median nerve.
o Repetitive / sustained wrist flexion/extension
o Repetitive gripping activities
o Swelling in the wrist due to local trauma
o Carpal dislocation
o Osteoarthritis
o Pregnancy (because of water retention)
o Rheumatoid arthritis and diabetes which decreases the space between tunnel
o Compression forces from sustained equipment usage
o Vibration against carpal tunnel.
• Clinical Presentation
o Increased pain and paresthesia in hand with repetitive use which may troubled by being
awakened at night.
o Progressive weakness / atrophy in thenar and first two fingers
o Decreased prehension in tip to tip, tip to pad and pad to pad. e.g. Buttoning clothes
o Inability to perform repetitive wrist or finger motion, e.g. cutting, fine tool manipulation.
o Sleep disturbance
o Irritability / sensory loss in median nerve disturbance area.
• Risk Factors
o Extrinsic factors - That increases the volume within the tunnel outside or inside the
nerve.
, Carpal Tunnel Syndrome
o Intrinsic factors - That increases the volume within the nerve and leads to increase
volume within the tunnel like tumors or tumors like lesions.
o Extrinsic factors - That alter the contour of the tunnel. e.g.
§ Fracture of distal radius
§ Fracture of carpus
§ Via post-traumatic arthritis.
o Extrinsic factors/ Conditions that alter fluid balance. e.g.
§ Pregnancy
§ Menopause
§ Obesity
§ Renal failure
§ Hypothyroidism
§ Use of oral contraceptives
§ Congestive heart failure
§ Alcoholism
§ vitamin toxicity
o Masses such as, myeloma, ganglia, lipoma, fibroma
o Environmental factors like, prolong postures in extreme wrist flexion or extension,
repetitive use of flexor muscles, prolong exposure to vibration etc.
• Physiotherapy Assessment of CTS
o Subjective Assessment
o Chief complaints and history
§ Patient complains about pain, paresthesia and numbness, reoccurring
periodically especially at night or early in the morning in the median nerve
distribution area. (palmar aspect of the thumb, index, middle, and half of the
ring finger.)
§ Waking at night with paresthesia
§ Paresthesia during activities involving the hand or wrist.
§ Weakness of the hand
§ Loss of dexterity.
§ History of distal forearm fractures with chronic median nerve compression.
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