Carpal tunnel syndromeCarpal tunnel syndrome

IntroductionIntroductionDefinitionDefinition Carpal tunnel syndrome (CTS) is defined as Carpal tunnel syndrome (CTS) is defined as compression of the median nerve at the carpal compression of the median nerve at the carpal tunnel of the wristtunnel of the wrist

Causes of compressionCauses of compression

* * Decrease in the size of the canalDecrease in the size of the canal * * Increase in the size of the contentsIncrease in the size of the contents

ManifestationManifestation

Pain and paresthesiaPain and paresthesia

EtiologyEtiology . .

DiabetesDiabetes

Rheumatoid arthritisRheumatoid arthritis

HypothyroidismHypothyroidism

PregnancyPregnancy local traumalocal trauma

Certain occupationsCertain occupations

. .

Diagnosis.Diagnosis. Visual analogue scale Visual analogue scale Clinical findings Clinical findings Grip strength Grip strength Electrophysiological studies Electrophysiological studies UltrasonographyUltrasonography

Differential Diagnosis Differential Diagnosis..

Clinical findingsClinical findings1- Tinel's sign is performed by lightly tapping the skin over is performed by lightly tapping the skin over

thethe flexor retinaculum to elicit a sensation of tingling or "pins and to elicit a sensation of tingling or "pins and

needles" in fingersneedles" in fingers innervated by the median nerveinnervated by the median nerve2- Phalen's maneuver

is performed by flexing the wrist gently as far as possible, then holding this position for one minute and awaiting

Symptoms

3- Durkan test ,carpal compression test, or applying firm pressure to the palm over the nerve for up to 30 seconds to elicit symptoms

Grip strengthGrip strengthPinch dynamometer was used to assess pinch muscle power. Hand dynamometer was used to assess maximal hand grip

Nerve Conduction Study (NCs)Nerve Conduction Study (NCs)

The room temperature was maintained around 31°C. For the motor nerve conduction studies, compound muscle action potentials ampilitude were recorded with a pair of surface recording electrodes placed on the abductor pollicis brevis muscle. The stimulating electrodes were placed at the wrist proximal to carpal tunnel for the distal segment stimulation witha distance of 7 cm from the recording electrode and at the elbow for the proximal segment stimulation.

The distal motor latency was measured from the onset of the stimulating artifact to the onset of the compound muscle action potential.

The nerve conduction velocity was also calculated to rule out any median nerve lesions such as polyneuropathy. In the study of sensory nerve conduction, a pair of ring electrodes were placed on the index finger for recording, and the sensory nerve was stimulated antidromically at the same site used for distal motor stimulation with a distance of 14 cm from the recording electrode. Sensory peak latency was measured from the stimulating artifact to the onset of the sensory nerve action potential.

Placement of distal segment stimulation

Placement of proximal segment stimulation

Treatment of CTS. Treatment of CTS. 1- Non surgical TTT1- Non surgical TTT

RestRest Occupational therapyOccupational therapy Acu laserAcu laser Local massageLocal massage Nerve mobilizationNerve mobilization

22 - -Surgical TTTSurgical TTT

Open carpal tunnel Open carpal tunnel releaserelease

Non surgical TTT Non surgical TTT

Hand splintHand splint Low level laser therapyLow level laser therapy Steroid therapySteroid therapy Nonsteroidal anti-inflammatory drugsNonsteroidal anti-inflammatory drugs

Ultrasound Ultrasound (1MHz, 1.0 W/cm², pulsed mode 1:5, 15 min/session )

Tendon gliding exerciseTendon gliding exercise

Wristsplint

Ultrasound

I.R, LASER 904nm

Median nerve mobilization in the form of wrist Median nerve mobilization in the form of wrist extension, supination, elbow extension, shoulder extension, supination, elbow extension, shoulder abduction, shoulder lateral rotation, and neck abduction, shoulder lateral rotation, and neck lateral bending to the opposite side will be lateral bending to the opposite side will be utilizedutilized

Tendon gliding Tendon gliding exerciseexercise

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