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Hand and Wrist (Pathologies (Carpal Tunnel Syndrome (Clinical Presentation…

- - - - Aggs - static gripping of objects
      - atrophy thenar eminence
      - Tingling and numbness
    - - Wrist bend
      - Finger Bend
      - Hand squeeze using ball.
    - - Median nerve compression
      - Repeated Stress
  - - - Clicking and Grinding
      - Weakness
      - Ulnar sided wrist pain
    - - Stretch
      - Strengthen
      - Rest
    - - Forced Ulnar Deviation
      - FOOSH
      - Compression loads on TFCC during marked ulnar deviation
      - OA
      - Degeneration
  - - - Pain and swelling radial styloid
    - - Splint
      - POLICE
      - Rest
      - Stretching thenar eminence
      - Steroid injection
      - ROM
      - Strengthening
    - - Inflam or entrapment of ext pollicis brevis and ab pollicis brevis
      - Repetitive wrist motion
  - - - Cast
      - stretching
      - Strength
    - - Aggs - pinching and gripping
      - Swelling bruising
      - Patient will feel dull deep ache radial side wrist
    - - FOOSH
      - No blood supply prox scaphoid
        
        Avascular necrosis
      - Presents in 2 ways
        
        Non - displaced, stable
        
        Displaced - unstable
        
        Displacement = ligament tear of wrist
  - - - POLICE
      - Stretching
    - - Painless clicking with digit movement
      - Stiffness and Swelling
      - Loss of ROM
    - - Abnormalities of gliding mechanism
      - Imflam of tenosynovium
      - Inflam of tendon of affected digit
- - - - The patient moves their hand into ulna deviation.
      - Positive test = Pain reproduced over the radial aspect of the wrist.
      - Forearm positioned in mid prone position, patient asked to flex the thumb and place their fingers over it.
      - Detects pain and limitation caused by inflammation between tendons of abductor pollicis longus (APL) and extensor pollicis brevis (EPB) and their shared synovial sheath at distal end of radius.
  - - - Compression is placed through the patients hand whilst ulna deviation is added – this may be enough to reproduce patients pain at the base of ulna.
      - If the above is asymptomatic TFCC stress is increased by ‘scooping’ the hand from flexion to extension whilst maintaining the ulna deviation and compression.
      - Therapist stabilises patients forearm, and places their other hand as if ‘shaking’ the patients hand.
      - Positive test = pain at ulna side of wrist, sometime accompanied by apprehension and/or a click or crepitus on movement.
  - - - Increases pressure on the median nerve as it passes through the carpal tunnel
      - Wrist flexion should be maintained for up to 1 minute
      - Positive test = paraesthesia over cutaneous distribution of the median nerve and/or pain
    - - As Phalen's
    - - The mid point of the carpal tunnel is identified and ‘tapped’ with a finger or percussion hammer.
      - Positive test = paraesthesia and/or pain over cutaneous distribution of the median nerve.
      - Forearm fully supinated, resting on the treatment couch and hand in neutral.