| CTS is a condition that results from the compression of the ______ nerve as
it passes through the carpal tunnel at the wrist | median |
| What are the 4 structures going through the carpal tunnel? | Median
FLEXOR DIGITorum profundus
FLEXOR DIGITorum superficialis
FLEXOR policis longus |
| Aside from acute injury to the carpal tunnel, such as dislocation, what are the other two general (idiopathic) causes for CTS? | - Causes leading to the increase in size of contents running through the Carpal Tunnel.
- Causes leading to decreased canal space that are chronic in nature. |
| What are 2 causes leading to increase in the size of the contents running through the tunnel that are chronic in nature? | - Repetitive actions of the wrist (swelling, as well as thickening of fibers via use growth and fibrosis)
- Scar Tissue (injury)
- Conditions that result in edema & fluid retention or connective tissue degeneration (diabetes, hypothyroidism, rheumatoid arthritis
& pregnancy) |
| What are 2 causes leading to decreased canal space that are chronic in nature? | - *Bony callus development* after a fracture of a carpal bone or distal radius
- Space occupying *lesions* such as ganglia, lipomas or cysts
- Conditions causing *bony growths* (Rheumatoid Arthritis) |
| What are 2 acute reasons for carpal tunnel syndrome? | - Trauma (fracture/dislocation)
- Infection (Acute exacerbation of RA)
- New activity (requiring repetitive wrist actions)
- Hematoma (which can occasionally occur in people with hemophilia or
those on anti coagulants) |
| What is the key difference between Pronator Teres Syndrome and Carpal Tunnel Syndrome? | The difference is that PTS compresses the median nerve at the pronator teres, and not the carpal tunnel (wrist) |
| What condition is this?
Patient has numbness in the thumb and index finger, with some weakness in the thenar muscles. Dull to sharp pain in the anterior forearm is experienced with repetitive elbow movement. | Pronator Teres Syndrome |
| What's the difference between Carpal Tunnel Syndrome and Repetitive Strain Injury? | Carpal Tunnel Syndrome is concerned mainly with the Median Nerve, where Repetitive Strain Injury concerns the muscles, tendons and nerves of the lower arm and wrist. |
| 18%-31% of women experience arm pain during pregnancy. Is it typically Carpal Tunnel Syndrome or a Repetitive Strain Injury? | Carpal Tunnel Syndrome.
RSI is caused by, as the name indicates, repetitive strain (use) of the arm. Carpal Tunnel can be caused by major hormonal, fluid and even psychological changes. |
| Is it relatively possible for someone with Carpal Tunnel to have hypertonicity in their lower arm? | Yes. While muscle wasting may occur in the area due to a pinching of the median nerve, and possibly, restriction of fluids, the person may also experience hypertonicity.
(Hypertonicity is common in the forearm flexors from overuse, and, often
from the presence of trigger points in these muscles and the hand.) |
| Point to the location of your flexor retinaculum | Image.
This is also known as the "Transverse Carpal Ligament". It is a superficial ligament.
This area is a common place to experience lesions/trigger points in carpal tunnel. |
| The thenar eminence muscles are often show signs of atrophy in late stages of Carpal Tunnel due to lower circulation and nerve weakness. Where is the thenar eminence? | Image. |
| Tissue texture may be boggy local to the wrist in carpal tunnel. The forearm muscles are often dense due to... what? | An accumulation of metabolic waste
(circulation of more than just blood is hindered in Carpal Tunnel; think of a pond vs. a lake... the lake is cleaner because it has continuous and adequate water flow, where the pond accumulates grime and slime, due to the water always being still). |
| Name one of the 3 tests for carpal tunnel. | Note that the Tinel's Sign can show a false positive; some people WITHOUT CTS will feel numbness and tingling from this test.
Positives from these tests will elicit the CTS symptoms. |
| What are sensations will a patient with carpal tunnel feel in their carpal area? | Pain, tingling, numbness |
| A pinched nerve in the vertebra can elicit carpal tunnel-like symptoms. Which two nerves would cause this, if pinched? | C6, C7
This would also likely cause neck pain and motor weakness in muscles innervated by C6 (biceps Brachii) or C7 (triceps brachii). Pain is released when neck stops moving. |
| In Thoracic Outlet Syndrome, Muscle wasting of the hypothenar muscles occurs, specifically over the ulnar border & over which two fingers. | Ring and baby fingers; they are the ones most directly inferior to the ulna. |
| Would having a pinched cervical nerve, thoracic outlet syndrome or pronator teres syndrome increase likelihood for carpal tunnel syndrome, or eliminate the possibility? | They all increase the chance of CTS. |
| Are any of the following wrong for the treatment of Carpal Tunnel Syndrome. Think carefully, because I like trick questions. | Nope, they're all correct. |
| For patient self-care, is it important for them to only focus on the posture of their neck, shoulders and thoracic area? | No; proper lower limb posture is also important for promoting proper flow of fluids and removal of metabolic waste. |
| For patient self-care of carpal tunnel syndrome, ice and "contrast baths" of the arms is recommended. What is a contrast bath? | More or less: Put your arms in the warm/hot bath for 3 minutes and then move to the cool/cold water for 30 seconds. Repeat this cycle 3 times. Always ending in the cool/cold water.
A bath where you alternate hot and cold water. This does not require the submersion of one's whole body, just the arm and wrist, so use of a bucket or sink is fine. |
| Should you recommend stretching the area of the lower arm, wrist and fingers to a carpal tunnel syndrome patient? | Yes, that's the best course of professional action. |
| Which arthritis causes contradictions to the typical way you would treat the patient's Carpal Tunnel, if/when it causes joint hypomobility and/or joint instability? | Rheumatoid Artheritis. |
| What autoimmune disease should prevent you from doing frictions on the patient's Carpal Tunnel, IF they have poor tissue health? | Diabetes |
