Carpal Tunnel Syndrome

Upper Extremity
Written By Julianne Madeline, OTD, OTR/L

Case study: You just received a referral for an OT evaluation and treatment in the outpatient setting for a patient with carpal tunnel of bilateral wrists. What are the essential elements of the evaluation and treatment?

Evaluation

  • Tinel’s sign: Positive sign is an electrical shock like sensation

  • Phalen’s Test

  • Carpal Compression Test: Compress over median nerve at the carpal tunnel; hold 30 seconds

  • Monofilament Test

Treatment

Splint/ Orthotic: Wrist Cock-Up Splint

  • Muscle Stretches/ Tendon Glides: Straight, hook fist, table top, flat/ straight fist, full fist (Avoid strengthening that involves a composite fist (Grippers, putty, bands)

    • Longitudinal nerve glides

      • Ipsilateral cervical side bending

      • Scapular elevation

      • Elbow flexion

        • Position forearm in supination

          • Perform gentle, midrange, rhythmic motion flexion/ extension

          • Index and middle finger

    • Transverse Glide

      • Radial glide of the first CMC joint to improve thumb retropulsion

      • Place hand into supination

      • Bring thumb into retropulsion/ alternate with opposition

  • Activity Management

  • Neural Mobilization

Julianne Madeline, OTD, OTR/L https://www.integrativeotinsights.com
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Distal Radius Fracture