Carpal Tunnel Syndrome

Patient present with

>> Women >Men Gradual Onset - Daily Pattern: worse at night or early in the morning tingling, numbness, pain can - Unilateral or bilateral Other possible symptoms of CTS include: a dull ache and discomfort in the hand, forearm or upper arm a burning, prickling sensation (paraesthesia) in the hand similar to pins and needles dry skin, swelling or changes in the skin colour of the hand becoming much less sensitive to touch (hypoaesthesia) weakness abduction and opposition of the thumb weakness and wasting away (atrophy) of the muscles in the thumb

Risk Factors

Investigation
Physical tests: Phalens, Reverse Phalens, Tinels sign , TOS, Nomal pulses (medial and ulnar arteries do not pass through the tunnel) Spurling test. Medial n. stretch. Ar mm test (pronator teres)

Physical examination of the hands, arms, shoulders, neck and back

Other tests: (NHS, 2013) Blood tests (diabetes , rheumatoid arthritis, hypothyroidism), Nerve conduction study, Electromyography, X-ray.

Management
Non-surgical treatments (Nice guidelines) *wrist splints *corticosteroid injections. There is a lack of evidence to support the use of non-steroidal antiinflammatory drugs (NSAIDs) such as ibuprofen for treating CTS, or for diuretics to help relieve fluid retention (NHS, 2013) *Carpal tunnel release surgery: Surgery is usually only recommended for severe cases of CTS, when symptoms last for more than six months or other treatments have not been effective. In a survey of more than 6,000 NHS carpal tunnel operations, 50% thought that the surgery had been completely successful, and a further 25% felt their symptoms were greatly improved. However, as with any form of surgery there is always a small risk of complications. Complications of CTS include: infection, failure during surgery to fully separate the roof of the carpal tunnel, usually resulting in persistent CTS symptoms, bleeding after the operation, nerve injury, scarring, persistent wrist pain, which may be different to the original symptoms , complex regional pain syndrome a rare but chronic (long-term) condition that causes a burning pain in one of the limbs Acupuncture may be effective for pain relief in the short-term, although there is no therapeutic benefit.

Osteopathy care options Consider cervical spine dysfunction, Ergonomics, pronator teres Combination of gentle soft tissue and articulatory techniques coupled with advice, stretches and exercises. Advise minimization of activities that exacerbate symptoms. Explain to people who work with computer keyboards that there is little evidence to suggest that modifications at their work place are likely to be of any help in relieving symptoms. Do not recommend the use of nonsteroidal anti-inflammatory drugs or diuretic medication.

During surgery the roof of the carpal tunnel, known as the carpal ligament, is cut to reduce pressure on the median nerve in the wrist (keyhole surgery > back to work in 2/3 days < open surgery >6 weeks recovery<)

Keyhole surgery http://www.youtube.com/watch?v=XA4xaB7MZ A4 Open http://www.youtube.com/watch?v=YVPe5WTl5y g