What are the signs or diagnostic criteria of Carpal Tunnel Syndrome?
Answer
The "carpal tunnel" consists of 9 tendons (Flexor Pollicis Longus, 4 tendons of the Flexor Digitorum Profundus and 4 tendons of the Flexor Digitorum Superficialis) and the median nerve. Due to the small space that these structures run through, they are prone to irritation. In fact, during composite finger flexion, these structures undergo changes:
Flattening/displacement of the median nerve
Proximal migration of the lumbricals
Pressure on FDP and FDS tendons
As a result of these structural changes, Carpal Tunnel Syndrome (CTS) can occur. The six diagnostic clinical criteria of CTS are:
Numbness and tingling in the median nerve distribution (thumb, index and middle finger).
Nocturnal numbness or exacerbation of symptoms at night
Weakness or atrophy of the thenar musculature
Tinel sign (Tapping on nerve produces symptoms.)
Phalen's test (Hyperextending wrists with both hands together produces the symptoms.)
Loss of 2 point discrimination
Research shows that the best CTS management strategies is splinting the wrist in neutral/slight flexion with slight ulnar deviation and the MPs in neutral in combination with lumbrical stretches. Ultrasound and neural flossing have found to be helpful. Activity modification such as performing activities with a neutral wrist position and 45 degrees of forearm rotation has also found to decrease the symptoms.
Ann Porretto-Loehrke, DPT, PT, CHT, COMT
Ann Porretto-Loehrke is a Certified Hand Therapist (CHT) and a Certified Orthopedic Manual Therapist (COMT) for treatment of the upper quadrant through the International Academy of Orthopedic Medicine-United States (IAOM-US). She earned a post-professional Doctorate in Physical Therapy (DPT) degree from Drexel University with a specialty in hand and upper quarter rehabilitation. Ann co-authored the chapter “Therapist’s Management of Other Nerve Compressions About the Elbow and Wrist” in the most recent edition of Rehabilitation of the Hand & Upper Extremity. She is the therapy manager at the Hand to Shoulder Center of Wisconsin, located in Appleton, Wisconsin. Ann is also the lead instructor for the Hand & Upper Extremity Track through IAOM, a manual therapy track designed specifically for hand therapists. She is a dynamic, passionate instructor who loves teaching and providing patient care.
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