Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome

Abstract

When examining a patient with suspected carpal tunnel syndrome (CTS), clinicians should use Semmes-Weinstein monofilament testing (SWMT), using the 2.83 or 3.22 monofilament as the threshold for normal light touch sensation and static 2-point discrimination on the middle finger to aid in determining the extent of nerve damage. In those with suspected moderate to severe CTS, clinicians should assess any radial finger using the 3.22 filament as the threshold for normal. Semmes-Weinstein monofilament testing should be repeated by the same provider. BIn those with suspected CTS, clinicians should use the Katz hand diagram, Phalen test, Tinel sign, and carpal compression test to determine the likelihood of CTS and interpret examination results in the context of all clinical exam findings.Clinicians should assess and document patient age (older than 45 years), whether shaking their hands relieves their symptoms, sensory loss in the thumb, the wrist ratio index (greater than 0.67), and scores from the Boston Carpal Tunnel Questionnairesymptom severity scale (CTQ-SSS) (greater than 1.9). The presence of more than 3 of these clinical findings has shown acceptable diagnostic accuracy. D There is conflicting evidence on the diagnostic accuracy and clinical utility of the upper-limb neurodynamic tests, scratch-collapse test, and tests of vibration sense in the diagnosis of CTS, and therefore no recommendation can be made. EXAMINATION -OUTCOME MEASURES: ACTIVITY LIMITATIONS/SELF-REPORTED MEASURES BClinicians should use the CTQ-SSS to assess symptoms and the Boston Carpal Tunnel Questionnaire functional scale (CTQ-FS) or the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire to assess function when examining patients with CTS. Clinicians should use the CTQ-SSS to assess change in those undergoing nonsurgical management. EXAMINATION -ACTIVITY LIMITATIONS/ PHYSICAL PERFORMANCE MEASURES C Clinicians may use the Purdue Pegboard (PPB) or the Dellon-modified Moberg pick-up test (DMPUT) to quantify dexterity at the onset of treatment and compare scores with established norms. Clinicians should not use the PPB test, Jebsen-Taylor Hand Function Test, or the Nine-Hole Peg Test to assess clinical change following carpal tunnel release (CTR) surgery. Clinicians may use the DMPUT to assess change following CTR surgery. EXAMINATION -ACTIVITY LIMITATIONS/ PHYSICAL IMPAIRMENT MEASURES Strength MeasuresA Clinicians should not use lateral pinch strength as an outcome measure for patients with nonsurgically or surgically managed CTS. B Clinicians should not use grip strength when assessing short-term (less than 3 months) change in individuals following CTR surgery.C Clinicians may assess grip strength and 3-point or tip pinch strength in individuals presenting with signs and symptoms of CTS and compare scores with established norms. D There is conflicting evidence on the use of tip and 3-point pinch strength and abductor pollicis brevis muscle strength testing in individuals following CTR surgery. Sensory and Provocative MeasuresC C...

Entrapment neuropathies: a contemporary approach to pathophysiology, clinical assessment, and management

“…For mild to moderate CTS, therapy usually includes advice, splinting, electrophysiological agents as well as manual therapy and/or exercises. 51 There is currently limited evidence for a short-term benefit of splinting compared to no treatment. 113 Splinting is recommended at night only.…”

“… 113 Splinting is recommended at night only. 51 A Cochrane review reported that there is limited evidence for a beneficial effect of exercise and mobilisation in the management of patients with CTS. 114 This was supported by another review suggesting that neural mobilisation did not improve clinical outcomes compared to other treatments.…”

“… 52 , 54 , 84 Given the limited literature available for the effectiveness of therapeutic management of CTS, the decision to provide physiotherapy/occupational therapy management should be based on the clinicians' expertise and patients' preferences 114 while following current treatment recommendations. 51 …”

Relationship between nerve conduction studies and the Functional Dexterity Test in workers with carpal tunnel syndrome

“…Its prevalence in the United States working population is 7.8% [ 1 ], with higher and increasing incidence in the industrial sector than in the general population [ 2 , 3 ]. Classic CTS symptoms and sensorimotor alterations include nocturnal pain associated with tingling, numbness, and - in more severe cases - weakness in the median nerve territory that affects the hand motor control, especially during activities involving the first three fingers [ 4 , 5 ].…”

“…A thorough history and physical examination are the key to diagnosis [ 4 ]. Thenar atrophy [ 6 ] and sensory loss [ 7 ] are common findings, but not always present in the early stages of the disease [ 4 , 8 ] and unable to rule out CTS [ 9 ]. Provocative tests aimed at reproducing the patient’s symptoms - such as the Phalen’s test and Tinel’s sign - are often used in the clinical setting, but there is no evidence to support their use as independent diagnostic tools [ 9 ].…”