Carpal tunnel syndrome(CTS) of Examination
Carpal tunnel syndrome(CTS) is really a compression
neuropathy of median nerve.It's constriction of median nerve because it passes
beneath the flexor retinaculum.Carpus is really a word derived from the Greek
word "karpos" meaning "wrist."
A physical exam with a focus on your neck,
arms, wrists, and hands is done if there is tingling, numbness, weakness, or
pain of the fingers, thumb, or hand. The exam is to help find out whether your
symptoms are caused by compression of the median nerve as it passes through the
carpal tunnel in the wrist (carpal tunnel syndrome).
1)Phalen's
test-The examiner flexes the patient's wrist maximally and hold it for one
minute by pushing the patient's wrist together.An optimistic test is shown by
tingling in the thumb,index,middle,and lateral 1 / 2 of ring fingers brought on
by pressure on the median nerve.
2)Reverse
phalen's (prayer)test-The examiner extends the patients wrist.The examiner then
applies direct pressure within the carpal tunnel for One minute.Positive test
produces same symptoms.
3)Tinel's
sign in the wrist-The examiner taps over the carpal tunnel in the wrist.A
positive test causes tingling and paraesthesia in to the thumb, index, middle
and lateral 1 / 2 of the ring finger.
4)Carpal
compression test-The examiner supports the supinated wrist in both the hands
and applies an immediate even pressure within the median nerve within the
carpal tunnel for upto Thirty seconds.Production of patient's symptoms is
recognized as a positive test.
Investigations-
CTS,
patients will often be tested electrodiagnostically with nerve conduction
studies and electromyography. The aim of electrodiagnostic testing is to
compare the rate of conduction within the median nerve with conduction in other
nerves offering the hand. When the median nerve is compressed, as with CTS, it
will conduct slower than normal and more slowly than other nerves. There are
lots of electrodiagnostic tests used to create a diagnosis of CTS, however the
most sensitive, specific and reliable test may be the Combined Sensory Index
(also called Robinson index).
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