Carpal Tunnel Syndrome

By
Dr . Sahar Mowad Abd Elmutilibe
Lecture in Orthopedic Physical Therapy department
Physical Therapy Faculty – Beni Suef University
 Definition

 Carpal tunnel syndrome is a common condition that

causes pain, numbness, tingling, and weakness in the
hand and wrist.

 It happens when there is increased pressure within the

wrist on a nerve called the median nerve. This nerve
provides sensation to the thumb, index, and middle
fingers, and to half of the ring finger. The small finger
(the “pinky”) is typically not affected. I
 Trabizum
hamate
capitate tabizaid
 What is the carpal tunnel?

 The carpal tunnel is a narrow canal or tube in the wrist

 this part of the wrist allows the median nerve and
tendons to connect the hand and forearm.

 The parts of this tunnel include:

 Carpal bones: These bones make up the bottom and
sides of the tunnel. They are formed in a semi-circle.
 Ligament: The top of the tunnel, the ligament is a
strong tissue that holds the tunnel together.
 Median nerve: This nerve provides feeling to most of
the fingers in the hand (expect the little finger). It also
adds strength to the base of the thumb and index finger.
-
-

's I Si

 Tendons: Rope-like structures, tendons connect muscles

in the forearm to the bones in the hand. They allow the
fingers and thumb to bend.
 Risk factors

 People at risk for carpal tunnel syndrome are those who do

activities or jobs that involve repetitive finger use.

 Motions that can place people at risk of developing carpal

tunnel syndrome include:
!High-force (hammering).
!Long-term use.
!Extreme wrist motions.
!Vibration.
 Many other factors can also contribute to the development of
carpal tunnel syndrome. These factors can include:

 Heredity (smaller carpal tunnels can run in families).

-I  Pregnancy.
-

 Hemodialysis (a process where the blood is filtered).

esene-
 Wrist facture and dislocation.
 Hand or wrist deformity.
 Arthritic diseases such as rheumatoid arthritis and gout.
 Thyroid gland hormone imbalance (hypothyroidism).
 Diabetes.
 Alcoholism.
 A mass (tumor) in the carpal tunnel.
 Older age.
 Amyloid deposits (an abnormal protein).
 Symptoms
 Tingling in the fingers. of median nerve interation.

 Decreased feeling in the fingertips.

 Difficulty using the hand for small tasks, like:

 Handling small objects.
 Grasping a steering wheel to drive.
 Holding a book to read.
 Writing.
 Using a computer keyboard.
 As carpal tunnel syndrome worsens , These symptoms
can include:

 Weakness in the hand. ‫حركات دقيقة‬

 Inability to perform tasks that require delicate motions

(such as buttoning a shirt).
‫تزرير القميص‬

 Dropping objects.

In the most severe condition, the muscles at the base of the

thumb visibly shrink in size (atrophy).
 DIAGNOSIS AND TESTS
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 Tinel’s sign: In this test, the physician taps over the median nerve at the wrist to see if
it produces a tingling sensation in the fingers.
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 Wrist flexion test (or Phalen test): In this test, the patient rests his or her elbows on a
table and allows the wrist to fall forward freely. Individuals with carpal tunnel
syndrome will experience numbness and tingling in the fingers within 60 seconds. The
more quickly symptoms appear, the more severe the carpal tunnel syndrome.
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-

 Durkan test : carpal compression test, or applying firm pressure to the palm over the
nerve for up to 30 seconds to elicit paresthesiaT
accurate
not
test
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 Hand elevation test : he hand elevation test is performed by lifting both hands above
the head. Paresthesia in the median nerve distribution within 2 minutes is considered
positive.

 X-rays: X-rays of the wrist may be ordered if there is limited wrist motion, or evidence
of arthritis or trauma.

 Electromyography (EMG) and nerve conduction studies: These studies determine how
well the median nerve itself is working and how well it controls muscle movement.
 Differential diagnosis

·a
 Cervical radiculopathy
D Cervical myofascial pain
 Carpometacarpal arthritis of thumb
& Flexor carpi radialis tenosynovitis
iu
inflammation and swelling of a tendon

contraction sola

 Rayonds disease
on
Raynaud's disease is a rare disorder of the blood
vessels, usually in the fingers and toes. It causes the
blood vessels to narrow when you are cold or feeling
stressed

& Degenerative arthritis of the hand

O Focal CNS pathology (tumor ، stroke)
 Treatment

Non-surgical treatments

Surgical treatments
 Non-surgical treatments

 Wearing a wrist splint at night.

NSAID
 Taking non steroidal anti-inflammatory drugs, such as
ibuprofen. NSAID

 Cortisone injections.
-joe's
 Raising or lowering your chair.
-
& I

26,5
 Moving your computer keyboard. y=81
-

 Changing your hand/wrist position while doing activities.

 Using recommended splints, exercises and heat treatments
from a hand therapist.
 specified neurodynamic techniques, functional massage, and
carpal bone mobilizations.
 Surgical treatments

 The goal of surgery is to increase the size of the

tunnel in order to decrease the pressure on the
nerves and tendons that pass through the space.
This is done by cutting (releasing) the ligament
that covers the carpal tunnel at the base of the
palm. This ligament is called the transverse
carpal ligament.
 have local anesthesia

 Be in brief discomfort for about 24 to 72 hours after

surgery. People usually experience complete nighttime
symptom relief quickly—even the night after surgery.
.‫ يوًما من الجراحة‬14 ‫ إلى‬10 ‫قم بإزالة الغرز بعد‬

 Have your stitches removed 10 to 14 days after surgery.

Hand and wrist use for everyday activities is gradually
restored by using specific exercise programs.
 ‫عدم القدرة على القيام بأنشطة ثقيلة مع اليد املصابة ملدة أربعة إلى ستة أسابيع‬

 Be unable to do heavier activities with the affected hand

for about four to six weeks. Recovery times can vary
depending on your age, general health, severity of carpal
tunnel syndrome and how long you had symptoms. You
will continue to gain strength and sensation in the
following year after surgery. ‫ستستمر في اكتساب القوة واإلحساس في العام‬
.‫التالي بعد الجراحة‬

 Have relief from most carpal tunnel syndrome

symptoms.
 Phase I

Maximum Protection Phase

 Usually a bulky dressing or splint is used following

surgery.
‫تجنب ثني املعصم النشط بعد الوضع املحايد‬

 Avoid active wrist flexion past neutral as well as

-
-

active finger flexion with the wrist flexed during the

first 10 days after surgery.
 Wound management, control of edema and pain.
 Active tendon-gliding and nerve-gliding exercises.
 activ = 1
- yll 55

flexion 51 is
 Exercises
Active finger and thumb flexion/extension,
abduction/adduction, and thumb opposition with the
wrist stabilized in moderate wrist extension

 Active wrist extension; this may be combined with

passive wrist flexion with the splint removed.

 Active radial and ulnar deviation of the wrist (with the

splint removed and the wrist supported in slight
extension), pronation and supination of the forearm, and
all shoulder and elbow motions.
 Phage 2

Moderate and Minimum Protection

Phases

‫الغرز‬

 The sutures are usually removed around the 10th

to 12th postoperative day, and more active
treatment is allowed.

 The patient should be able to return to full activity

by 6 to 12 weeks. Impairments may include ‫قد تشمل اإلعاقات‬

‫الضعف املتبقي‬
-
residual weakness and sensory deficits, persistent
-
-

edema, limited motion, hypersensitivity, and pain

- -
-
 Scar tissue mobilization.

 Progressive stretching and joint mobilization of

restricted tissue

 Muscle performance :
Begin strengthening exercises- 4 weeks after surgery with
isometric exercises. Progress to grip and pinch exercises
by ⑳
6 weeks. Emphasize strength, coordination, and
endurance toward functional
goals
 PREVENTION

B
 Workstation changes—proper seating, hand and wrist
placement—can help decrease some factors that can lead to
carpal tunnel syndrome.
 Sleeping with your wrists held straight.
 Keeping your wrists straight when using tools.
 Avoiding flexing (curling) and extending your wrists repeatedly.
 Decreasing repetitive/strong grasping with the wrist in a flexed
position.
 Taking frequent rest breaks from repetitive activities.
 Performing conditioning and stretching exercises before and
after activities.
3
 Monitoring and properly treating medical conditions linked to
carpal tunnel syndrome. .‫مراقبة الحاالت الطبية املرتبطة بمتالزمة النفق الرسغي وعالجها بشكل صحيح‬