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).