Hi I’m Dr. Matti Palo and I just Wanted to take a moment to describe the way patients present to my clinic with a diagnosis of carpal tunnel syndrome so patients typically come to my clinic with complaints of either sensory or motor changes along the distribution of the median nerve so the median nerve as we’ve already learned is a nerve comes from the neck goes down the arm through the carpal tunnel and branches to supply sensation to the thumb Index, long, and half of the ring finger so when I say patients have sensory.
Changes what i’m talking about is they feel different in this distribution may be its hypersensitive maybe it’s Not as sensitive maybe it’s numb maybe it’s pain again in these fingers probably the most common complaint I here people wake up in middle of the night shaking their hand trying to get sensation come back to those fingers the reason this works is it actually relieves some of the blood flow problems that occur with carpal tunnel so let’s talk about some of the other things that people complain about sometimes.
They complain about weakness in the hand they complain about dropping objects and one of the reasons this occurs is because the nerve actually has a branch after it goes through the carpal tunnel that comes back in supply sensation to this part on the thumb this part of the thumb is called thenar eminence and what will happen usually with advance carpal tunnel is this musculature will start to Kind of waste away and that will that’s what we call thenar atrophy You know atrophy just like you have When you wear a Cast on your leg.
Carpal tunnel Syndrome Diagnosis
Your calf atrophies most people are familiar with that well thenar atrphy is the same idea but it’s in your hand and this leads to weakness in the hand and that’s what makes people start to have that dropping problem or the weakness problem In the hand, so that’s probably the most common way people present to my clinic with numbness and tingling in the hand now the National Institute of Occupational Safety and Health defines carpal tunnel syndrome as having two or more the following criteria one or more the following symptoms.
Affecting at least part the nerve distribution of hand again the median nerve comes from neck goes down the arm Through the Carpal Tunnel and supplies sensation to the thumb Index, long, and half of the ring finger so if you have either paresthesia which means it just doesn’t feel quite Right, it’s a little less sensitive than normal Hyperesthesia which means it feels super sensitive pain or numbness and that is criteria number one being met for carpal tunnel syndrome so you have one of those symptoms plus one of the signs which means a physical exam finding that we’re about to talk about.
Then you by definition have carpal tunnel syndrome so let’s talk about the signs so if you have a positive tinel sign, a positive Phalen test result or diminished sensation to pinprick in the median nerve distribution that’s considered a positive sign on physical exam. Now let’s go through each of those test positive Tinel test means that when you tap above this crease this is called the distal wrist flexion crease when you tap right above that crease and you feel shocking sensation going into the these fingers that’s carpal tunnel syndrome.
The Phalen test consist of putting your arms in a bent up position a Lot of times people rest them on a table putting the backs Of the hands together and fully flexing the wrist a positive test means you get numbness or tingling in that distribution of the medial nerve sometimes the test takes up to a minute to become positive but if it’s positive that’s considered a positive finding so I’m starting to get Numbness and tingling right now because I have Carpal Tunnel Syndrome So I’m going to shake them awake.