median nerve. The body constricts tissues when it is cold, which only furthers exacerbates the compression factor of the median nerve. ● Relax the hands and wrists often. We often do not realize how much tension we are holding in our hands and wrists when performing basic daily tasks such as driving, writing, using our phones, typing on a keyboard, or gripping objects. Softening our hands and wrists during these activities can release muscular tension that contributes to the compression of the median nerve. ● Take frequent breaks during a work shift. Carpal tunnel syndrome is often referred to as a repetitive-stress syndrome. Taking breaks allows muscles involved with compression of the median nerve to relax and avoid excessive inflammation. A 10-minute break per each 50-minute period of work is a general recommendation. With severe cases that involve a lot of pain, breaks up to 20 to 30 minutes per a 30 to 40-minute work load is recommended. ● Wearing splints will keep the anatomical structures of the wrist and hand in healthy alignment, easing restrictions and compressions of the median nerve. Carpal tunnel symptoms may worsen at night, thereby making it necessary to splint the wrists while sleeping. Splinting during the day may be necessary if one’s occupation involves dexterous hand motions, such as typing and writing. ● If the forearms become achy, running cold tap water over the muscles or immersing the forearms in cold water for 30 seconds will help relieve inflammation. ○ Tinel’s Sign: Positive on the right side, with tingling in the median nerve distribution upon tapping the carpal tunnel. Diagnostic studies ● Nerve conduction studies (NCS): Demonstrated prolonged distal motor latency and reduced sensory conduction velocity in the right median nerve. ● Electromyography (EMG): Showed evidence of denervation in the muscles innervated by the median nerve. Diagnosis Based on the clinical presentation, physical examination, and diagnostic studies, the patient was diagnosed with carpal tunnel syndrome (CTS) in the right hand. Management and treatment Conservative treatment: ● Activity modification: Advised to take frequent breaks during typing and use ergonomic keyboards and mouse. ● Wrist splints: Recommended wearing a wrist splint, especially at night, to keep the wrist in a neutral position. ● Physical therapy/occupational therapy: Referred to a physical/occupational therapist for nerve gliding exercises and education on proper hand mechanic. ● Massage therapy: Included in her treatment plan to reduce muscle tension and improve circulation in the wrist and forearm; she received regular sessions focused on the forearm, wrist, and hand muscles, which provided some symptomatic relief. Medical management: ● NSAIDs: Prescribed nonsteroidal anti-inflammatory drugs for pain management.
create injury to the anatomical structures of the carpal tunnel region, thereby undoing much of the progress made in massage therapy treatments, as well as further exacerbating an already-weakened region. ● Employ stretching as often as possible. A general recommendation is to stretch every day for at least 10 minutes. If pain is present when an activity or an exercise is performed, pausing to stretch can prevent injury and allow restricted tissue to free and ease pressure from the median nerve. ● Topical agents (such as analgesic creams, gels, and rubs) can bring temporary relief to carpal tunnel–related pain. There are three main ingredients of these agents: Counterirritants such as menthol and camphor, which create a burning or cooling sensation to mask pain; salicylates, which relieve pain in the same manner as aspirin; and capsaicin, which creates a warming sensation to ease nerve pain. ● Self-massage techniques to bring temporary relief to carpal tunnel related pain. Pressing with moderate pressure (never deep enough to cause pain) into the thenar (thumb pad) or hypothenar (pinky pad) muscles can ease pressure within these muscle groups. Massaging into the anterior antebrachium (front side of forearm) can take pressure off the major muscle group, causing compression upon the median nerve. ● Elevate the hands and wrists whenever possible if there is fluid retention coupled within the usual carpal tunnel symptoms, especially in the case of bone fractures, neurological disease, or pregnancy. ● Keeping the body warmer will likely keep forearm and hand muscles looser, easing the compression of the Case study Mary Thomas, a 42-year-old administrative assistant, presented to the clinic with complaints of numbness, tingling, and pain in her right hand. She reported that these symptoms had been present for the past six months and were progressively worsening. The symptoms were particularly severe at night, often waking her from sleep. She also noticed weakness in her right hand, which made it difficult to grip objects and perform daily tasks. The patient reported that her symptoms began insidiously with occasional tingling in the fingers, particularly the thumb, index, and middle fingers of her right hand. Over time, the tingling became more frequent and was accompanied by a burning pain. She mentioned that her job required extensive use of a computer, with long hours of typing and data entry. She had tried over-the-counter pain medications, wrist splints, and rest, but found little relief. She also tried modifying her workstation ergonomics by adjusting the height of her chair and desk, but this did not significantly alleviate her symptoms. Physical examination ● General: The patient was in no acute distress. ● Neurological examination: ○ Sensation: Decreased sensation to light touch and pinprick in the distribution of the median nerve in the right hand (thumb, index, middle, and radial half of the ring finger). ○ Motor: Weakness of the abductor pollicis brevis muscle on the right. ○ Reflexes: Reflexes were normal. ● Special tests: ○ Phalen’s Test: Positive on the right side, with reproduction of symptoms after one minute of wrist flexion.
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Book Code: MIL1226
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