New Treatment of Carpal Tunnel Syndrome

Reverse Carpal Tunnel Syndrome

Carpal Tunnel Master, created by Hilma Volk, is a new carpal tunnel syndrome treatment course that covers advanced treatment plans, safe methods, exercises, and detailed instruction on how to eliminate the numbness, tingling, and pain in their hands, wrist, fingers, and forearms. This program does not involve in any type of gizmos, drugs, cortisone, drugs, surgery, or clunky gadgets. By using the method in this program, you could prevent, reverse, and even eradicate your carpal tunnel syndrome naturally. Also, every symptom of carpal tunnel syndrome will go away. No special equipment needed when using this product. You should know that nothing is perfect and this program does not always work. Each person has different cases of histories of medical conditions, injuries, and occupational conditions. So, to get the best result, you should follow exactly the guidelines inside this program. Continue reading...

Reverse Carpal Tunnel Syndrome Summary


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My Reverse Carpal Tunnel Syndrome Review

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I've really worked on the chapters in this book and can only say that if you put in the time you will never revert back to your old methods.

All the modules inside this ebook are very detailed and explanatory, there is nothing as comprehensive as this guide.

Carpal tunnel syndrome

Carpal tunnel syndrome is the most common com-pressive neuropathy at the wrist and may be associated with sporting activities secondary to flexor tenosyn-ovitis or lumbrical muscle hypertrophy as well as an extension injury 3,7 . The signs and symptoms of carpal tunnel have been well described the patient presents with pain and paresthesias in the first, second and third digits of the hand, which can radiate along the course of the nerve. Frequently patients complain of nocturnal awakening, pain and paresthesias. Physical examination includes provocative tests such as Phalen's sign, carpal tunnel compression sign, and Tinel's sign. Electromyography and nerve conduction velocities are helpful in confirming the diagnosis and noting the severity of the condition 3 . It is important to rule out other causes of median nerve compression such as pronator syndrome, anterior interosseous syndrome and cervical radiculopathy. Treatment of carpal tunnel syndrome begins with splinting, especially...

Median Neuropathy Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is one of the most common mononeuropathies. It typically occurs within the confines of the carpal tunnel in the wrist. The median nerve can also be entrapped in the forearm as a pronator or interosseous syndrome. The entrapment can be caused by anything that causes a decrease in the size of the carpal tunnel (e.g., Colles' fracture, rheumatoid arthritis, congenital carpal tunnel stenosis), enlargement of the median nerve (e.g., diabetes, amyloidosis, thyroid disease, neuroma), or an increase in the volume of other structures within the carpal tunnel (e.g., tenosynovitis, ganglion, gout, urate deposits, lipoma, hematoma, fluid retention in pregnancy).

Carpal Tunnel Syndrome The Mouse That Made You Roar

Carpal tunnel syndrome is named after the tube or tunnel that passes through the carpal bones (hence the name carpal ) in the heel of the hand. The prime pain spot is located in the area where the hand meets the wrist. If the size of the tunnel is reduced, pressure is put on the median nerve, producing the characteristic numbness and pain of carpal tunnel syndrome. Carpal tunnel syndrome has become famous as a work-related, repetitive strain injury (see Chapter 10, Injuries Taking the Ouch out of the Oops ), but more than half of all patients cannot trace their condition to a particular activity.

Wrist Splints

Jas Extension Splint

When used to control articular motion, wrist splints affect motion of the multiple carpal joints in a similar manner. They may be used to immobilize, mobilize, restrict motion, or transmit torque. It is important to understand that in order to control digital extrinsic muscle tendon glide, the wrist must be included in the splint. Recommendations and designs for wrist splints are numerous. Much of this is due to the proliferation of upper extremity cumulative trauma cases over the past few decades. Currently, no specific splint design has been proven to prevent the occurrence of cumulative trauma, but splints seem to be effective at decreasing or eliminating symptoms on a case-by-case basis. With all wrist splints, whether designed to immobilize, mobilize, restrict motion, or transmit torque, care must be taken to diminish pressure over bony prominences such as the ulnar styloid process, the first metacarpal, and the head of the radius, and to avoid pressure over the superficial...

Tumors Of Nonneural Origin

The lipomatous hamartoma does deserve special mention because this is a congenital fatty-fibrous lesion that usually occurs during childhood as a mass lesion associated with sensory findings. The majority of cases are associated with the median nerve in the palm or at the wrist, although lipomatous hamartomas have been reported in the foot. The treatment of choice is decompression of the nerve (e.g., carpal tunnel release) rather than an attempt at removal of lipomatous tissue, because this tissue is interdigitated between the axons of the nerve and is not feasible to remove.14

Forearm Wrist Thumb Splints

Wrist Ext Self Mobilization

The integrity of the wrist joint with its complex anatomic and motion architecture has been established as the key to hand function. It is uniquely vulnerable to a variety of injury and disease processes that may result in pain, stiffness, or instability, which may interfere with normal upper extremity function at all levels. The management of these wrist maladies may be substantially enhanced by proper splinting with objectives ranging from pain relief and protection to prevention and correction of deformity. In addition, wrist splinting may be used to negate or augment long extrinsic tenodesis functions in the management of digital pathologic conditions. Postoperative splinting protects healing structures while allowing predefined motion to involved and noninvolved joints. Therefore, it is imperative that careful consideration be directed toward the anatomic, kinesiologic, and functional effects of any splint created to traverse this important joint. Fig. 13-27 A,B, Forearm...

Autonomic Dysfunction Secondary to Focal Central Nervous System Disease

Vasomotor disorders in the limbs include Raynaud's phenomenon, acrocyanosis, livedo reticularis, vasomotor paralysis, and erythromelalgia. Raynaud's phenomenon is the episodic, bilateral, symmetrical change in skin color (pallor, followed by cyanosis and terminating in rubor after rewarming) that is provoked by cold or emotional stimuli. This response is due to episodic closure of the digital arteries. There is, however, no consistent evidence of exaggerated sympathetic outflow to the skin. Raynaud's phenomenon may be associated with connective tissue disease (e.g., scleroderma, rheumatoid arthritis, psoriasis), occupational trauma (such as the use of pneumatic hammers, chain saws producing vibration), the thoracic outlet syndrome, the carpal tunnel syndrome, or certain drugs (e.g., beta blockers, ergot alkaloids, methysergide, vinblastine, bleomycin, amphetamines, bromocriptine, and cyclosporine). y Vasomotor paralysis may be seen in patients with lesions of the sympathetic pathways...

Splints Acting on the Wrist and Forearm

Wrist Splints It is also important that the effect of wrist position be thoroughly considered in the preparation of any hand splint. Wrist dorsiflexion tightens extrinsic flexor tendons and permits the synergistic wrist extension-strong finger flexion function employed in power grasp. Wrist palmar flexion tightens the long extrinsic extensor tendons, allowing the hand to open automatically, while greatly reducing digit flexion efficiency. Splints designed either to relax or protect extensor tendons or to promote active digital flexion should support the wrist in an appropriate degree of dorsiflexion as determined by the presenting pathology. Conversely, splinting the wrist in a flexed attitude enhances active digital extension or allows protection for flexor tendon healing. One must take care, however, to avoid positioning the wrist in either excessive palmar flexion or dorsiflexion, which could lead to attenuation of delicate soft tissue structures or cause pressure on the median...

Mecanism Of Centripetal Lipid Accumulation Supraclavicular Fat And Face

Hypersecretion of GH is related to a somatotroph adenoma in 98 of cases. Approximately 20 of GH-secreting adenomas also secrete PRL. Other causes include excess GHRH from a hypothalamic hamartoma or choristoma, or from ectopic production (i.e., bronchial carcinoid, pancreatic islet cell tumor, or small-cell lung cancer). Hypersecretion of GH leads to the clinical syndrome of acromegaly in adults and gigantism in children. Acromegaly is characterized by an enlarged protruding jaw (macrognathia) with associated overbite enlarged tongue (macroglossia) enlarged, swollen hands and feet resulting in increased shoe and ring size coarse facial features with enlargement of the nose and frontal bones and spreading of the teeth (Table 6-1). Musculoskeletal symptoms are a leading cause of morbidity and include arthralgias leading to severe debilitating arthritic features. Skin tags hyperhidrosis (in up to 50 of patients), often associated with body odor hirsutism deepening of the voice...

Endoneurial Fluid Dynamics

Extrafascicular mechanical compression and the resultant ischemia certainly contribute to the symptomatology of entrapment neuropathies. But, it is quite likely that there are other factors more closely tied to the endoneurial microenvironment that affect the susceptibility and evolution of the nerve injury. For example, it is hypothesized that the initial event in the evolution of an entrapment neuropathy is the limitation and reduction of EFF due to externally applied mechanical forces. Secondly, elevation of EHP due to obstruction of EFF and continued application of these external forces leads to endoneurial ischemia and its attendant pathology. Additionally, the reduced compliance of the aged nerve (69) makes it more susceptible to externally applied mechanical pressures causing an elevation of EHP. This hypothesis is consistent with the paucity of carpal tunnel syndrome (CTS) in arcade game-playing teenagers, higher incidence of CTS in conditions with increased tissue water...

Accreditation Commission for Acupuncture and Oriental Medicine AGAOM

Immune systems, 151 nausea, 149-150 pain, 150-151 carpal tunnel syndrome, 75-77 CFIDS, 221 childbirth, 160-162 constipation, 188-189 coughing, 126 cupping, 43 dental pain, 62-64 depression, 208-209 dianhea, 190 acupressure, 4, 9-10, 19, 21-24, 27-29, 74, 86, 128-131, 239-241 acu-points, 5-7, 63-64, 238 allergies, 116-117 anxiety 210-211 arthritis, 78-79 asthma, 118-120 back pain, 82-85 bladder infections, 182-184 bronchitis, 121 bursitis, shoulders, 70-71 cancer, 151-153 carpal tunnel syndrome, 76-77 colds, 124-125 constipation, 188-189 dental pain, 62-64 diarrhea, 190 dysmenorrhea, 169-170 eczema, 196-197 elbow pressure, 30-31 electrical currents, 8 endometriosis, 177-179 facelifts, 199-200 feet, reflexology, 24-25 finger pressure, 30 foot pressure, 31-32 headaches, 61 hypertension, 220-221 IBS, 186-187 indigestion, 192-193 Chinese Medicine, 278 Traditional Chinese Medical College of Hawaii, 278 carpal tunnel syndrome, 75-76 CFIDS, 221 carpal tunnel syndrome, 75-76 circulation, back...

Mixed Connective Tissue Disease

The peripheral nervous system is a more frequent target of MCTD than the central nervous system. In published series, unilateral or bilateral trigeminal neuropathy occurs in about 10 percent of MCTD patients. y , y , '1011 The maxillary and mandibular branches are usually involved. '1021 Some patients may have involvement of the motor root with masseter atrophy.y , '1021 Although dysfunction of regional cranial nerves is rare, associations with facial neuropathy have been reported. W , '1031 Vasculitic polyneuropathy has been reported in up to 10 percent of patients with MCTD. y There have been rare reports of carpal tunnel syndrome'104 and neuromuscular junction dysfunction. yj The importance of myositis in MCTD is underscored by its inclusion as a diagnostic criterion in virtually all series of patients. y Concurrent changes of overlying skin mimic dermatomyositis in some patients. '951

Short Opponens Hand Splint

Wrist Extension Mobilization Splint

Splinting median nerve injuries depends on the level of lesion and the etiology.83,110 Emphasis is placed on maintenance of passive mobility of the involved joints and enhancement of function. High, proximal interruption may require splints that assist finger flexion as well as opposition of the thumb.30 Emphasis may be reduced to the prevention of thumb web contractures after more distal loss (Fig. 15-13). Splinting is frequently used in treating nerve entrapment problems such as carpal tunnel syndrome.* An understanding of each patient's functional capacity and substitution patterns is important before a splint design is initiated. For example, many patients whose long thumb flexor or short abductor and opponens action has been lost achieve adequate thumb use through substitution of the abductor pollicis longus, flexor pol-licis brevis (deep head), and adductor pollicis.

Triangular Fibrocartilage Complex Injuries

One of the most common complaints about the wrist is ulnar side wrist pain. Injuries to the TFCC usually occur as the result of a hyperextension, ulnar deviation, and axially loading force and can also be found in association with distal radius fractures. However, not all disruptions of the TFCC are traumatic in nature, as inflammatory and degenerative conditions can also lead to TFCC pathology. Patients presenting with TFCC injuries may report ulnar side wrist pain, occasional clicking, loss of grip strength, and pain with pronation and supination. The mechanical symptoms may improve with rest and are worsened with loading. A complete history including any history of trauma or repetitive use injury should be taken and a complete examination of the wrist should be performed. Traumatic injuries may present with a pop and immediate pain and swelling, and chronic Findings are always compared to the contralateral wrist and should be compared on multiple positions of forearm rotation....

Flexor Tendon Injuries

Small Finger Flexor Tendon Repair

Diagnosis may be made clinically by demonstrating the inability to flex the DIP joint of the small finger as well as noting tenderness over the hook of the hamate. Fractures may be well demonstrated by supinated carpal tunnel views on radiographic examination or computed tomography scan. Tendon rupture may be apparent on magnetic resonance imaging. Treatment of the tendon rupture, if isolated to the flexor digitorum profundus of the small finger, may be accomplished by transfer of the flexor digitorum sublimis of the ring finger or side-to-side repair to the adjacent profundus to the ring. If multiple tendons are ruptured, primary repair may be considered, although frequently a bridge graft using flexor digitorum sublimis or free tendon graft is necessary.

Familial Amyloid Polyneuropathy

This form was originally described in families of Swiss origin in Indiana and of German origin in Maryland. Patients present in middle life, commonly with bilateral carpal tunnel syndrome and vitreous opacities. Some patients, particularly males, have a more generalized neuropathy, with motor features in the upper limbs that then spread to the lower limbs. Autonomic neuropathy can occur, but both this and the generalized neuropathy are rarely disabling. Hepatosplenomegaly may occur. The vitreous abnormalities can cause severe visual impairment. The original cases had a Ser 84 or His 58 TTR point mutation, but a variety of other mutations have been described.y , y FAP Type 3 (Iowa). This disorder has many features in common with FAP type l. Upper and lower extremities are affected, but usually there is no associated carpal tunnel syndrome. Peripheral neuropathy can be severe, but the autonomic neuropathy is less prominent. Peptic ulceration may occur, and renal...

Compressive Neuropathies

The median nerve is subject to compression at the wrist, where it accompanies the flexor tendons as they pass beneath the volar carpal ligament. This region, the carpal tunnel, is a closed space within which pressure may rise. Studies with recording wicks placed in the canal show that flexion or extension elevate the canal pressure and that thickening of tendon sheaths or encroachment by other structures leads to a sustained rise in pressure within the canal.y Compression of the median nerve at the wrist then leads to the carpal tunnel syndrome (CTS), the most common of the Management. Many patients with CTS are managed successfully by conservative means, '341 with reduction of any activity that may exacerbate tenosynovitis, use of a wrist splint, and oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen 1600 mg day or naproxen 750 mg day. The splint should hold the wrist in a few degrees of extension's and may be worn at night or...

Acupuncture Yoga and Homeopathic Remedies

Excellent reviews of acupuncture's theory, efficacy, and practice (Kaptchuk, 2002 Nielsen and Hammerschlag, 2004) cite the 1997 NIH Consensus Development Panel findings on acupuncture. After reviewing all available evidence from RCTs up to 1997, the panel concluded that clear evidence shows that acupuncture is efficacious for adult postoperative and chemotherapy nausea and vomiting and for postoperative dental pain. The panel also reported that acupuncture should be considered a useful adjunct for addiction, stroke rehabilitation, osteoarthritis, headache, low back pain, tennis elbow, menstrual cramps, carpal tunnel, and fibromyal-gia (NIH, 1998).

Evaluation of Joint and Other Musculoskeletal Symptoms

Musculoskeletal Scleroderma

Precise anatomic localization of pain is the first task of the physician caring for a patient presenting with joint pain, while also evaluating stiffness, redness, warmth, or swelling in the absence of trauma. It is important to distinguish pain that is truly articular from periarticular pain. Causes of localized periarticular pain include bursitis, tendonitis, and carpal tunnel syndrome, whereas fibromyalgia, polymyalgia rheumat-ica, and polymyositis all can cause diffuse periarticular pain.

Clinical Uses of Nerve Conduction Studies

At sites of entrapment of the nerve by neighboring anatomical structures. Common entrapment neuropathies include compression of the median nerve at the wrist (carpal tunnel syndrome) the ulnar nerve at the elbow, cubital tunnel, or Guyon's canal and the peroneal nerve at the head of the fibula. Electrophysiological studies are very important in localizing the lesion in such disorders and also in excluding the possibility of a subclinical polyneuropathy manifest primarily by the entrapment neuropathy. The findings depend on the duration and severity of nerve damage, the rapidity of its evolution, and the underlying disorder. y

Hook of the Hamate Fracture 241 Clinical Presentation

This mechanism may also compress the terminal branches of the ulnar nerve, producing sensory and motor changes. As a result, patient symptoms include reduced grip strength, numbness and tingling in the distribution of the ulnar nerve, as well as ulnar sided wrist pain. Hamate fractures may go undiagnosed until there is rupture of the long flexor tendon of the small finger. Early examination reveals tenderness over the hook of the hamate. Swelling may or may not be prominent. Plain x-rays of the wrist do not image the fracture. Instead, carpal tunnel views with the wrist in dorsiflexion or an ulnar oblique view must be ordered.


CARPAL TUNNEL Two synovial sheaths envelop the flexor tendons as they cross the carpal tunnel. One is for the flexor digitorum superficialis and profundus and one is for the flexor pollicis longus. Trauma or inflammation of either sheath can cause tenosynovitis. The carpal tunnel lies deep to palmaris longus and is bounded by four boney landmarks (the pisiform, the hook of hamate, the tubercle of scaphoid, and the tubercle of trapezium). The tunnel's upper boundary is the transverse carpal ligament its lower border is the carpals. If the tunnel space is reduced, the median nerve is compressed and sometimes the flexors are affected. Some common causes of carpal tunnel problems are

Upper Extremity Blocks

Studies of perineural steroid injection, generally combined with local anesthetic, for the treatment of carpal tunnel syndrome were examined by Abram.143 Initial efficacy was found in multiple studies to range from 77 to 92 . However, many studies that followed patients for at least 1 year found continued benefit in only 13 to 22 . A prospective, randomized, double-blinded, placebo-controlled study measuring the short-term efficacy of steroid versus saline injection into the carpal tunnel was performed by Girlanda and associates.143 Thirty-two patients whose clinical diagnosis of carpal tunnel syndrome was supported by electromyographic and nerve conduction findings were included. Half of the affected nerves were randomly assigned to receive 15 mg methylprednisolone and half to receive saline. A scoring system was devised, incorporating symptoms such as pain and paresthesias and signs such as weakness and atrophy. Repeat electrophysiologic data were also gathered at routine intervals...

Reflex Sympathetic Dystrophy And Causalgia

Causalgia may occur in up to 5 percent of patients after partial peripheral nerve injury, but it does not occur when a nerve is completely severed. The incidence of RSD is 1 to 2 percent after various fractures but is particularly common following Colles' fracture, occurring in about 30 percent. RSD may occur after various other injuries including minor soft tissue trauma, operations such as carpal tunnel release and arthroscopic knee surgery, myocardial and cerebral infarction, and frostbite and burns. In up to 25 percent of RSD cases, a precipitant cause is not identified. RSD occurs in all ages with a median of 40 years. Females account for about 70 percent of cases.

History and Geography

Paget's disease is not a new disease, having been suspected in a Neanderthal skull. Although isolated case reports in the mid-nineteenth century describe what is now called Paget's disease, the classical clinical description by Paget and a pathological description by Henry Butlin clarified this entity in 1876. Paget was a major figure in the medical community, having been knighted at the age of 43, at which time he began his observations of the first patient with the bone disease that would bear his name. He is also credited with having defined such diseases as Paget's disease of the breast, rectum, and skin carpal tunnel syndrome and trichinosis. Paget's disease of bone is unique in that it affects only adult humans reports of Paget's disease in animals are not convincing. A childhood osseous condition called juvenile Pagefs disease appears to be a separate entity.

Fascial Layers Of The Palmar Side Of The Hand Figure 331a

Form a tunnel that encloses the flexor tendons of digits 2 to 5 and the tendon of the flexor pollicis longus muscle and their associated synovial sheaths. Flexor retinaculum (transverse carpal ligament). Forms a roof over the concavity created by the carpal bones, forming a tunnel (i.e., the carpal tunnel). The median nerve and the tendons of the flexor digitorum superficialis, flexor digito-rum profundus, and flexor pollicis longus muscles, and their associated synovial sheaths, pass through this tunnel. The flexor retinaculum anchors medially to the pisiform and the hook of the hamate. Laterally, the flexor retinaculum is anchored to the scaphoid and trapezium.

Dorsal Carpal Ganglion DCG

Wrist pain and tenderness, especially with palmar flexion, which may decrease grip strength and range of motion.45 A wrist extension immobilization splint, type 0 (1) is fabricated to reduce local area stress. A Silastic cover over the ganglion is secured with elastic wrap, allowing use for sports while protecting the DCG. If relief is not achieved with these conservative

DeQuervains Tenosynovitis

Flexor Tendon Nodule

Figure 30-18 Cross-sectional anatomy of the carpal tunnel, bounded on three sides by the carpal bones and volarly by the transverse carpal ligament. Nine flexor tendons and the median nerve pass through the tunnel. Anything that causes increased pressure in this canal can produce the symptoms of carpal tunnel syndrome. Figure 30-18 Cross-sectional anatomy of the carpal tunnel, bounded on three sides by the carpal bones and volarly by the transverse carpal ligament. Nine flexor tendons and the median nerve pass through the tunnel. Anything that causes increased pressure in this canal can produce the symptoms of carpal tunnel syndrome. Figure 30-19 Carpal tunnel nerve glide exercises.

Reviews And Selected Updates

Rosenbaum RB, Ochoa JL Carpal Tunnel Syndrome and Other Disorders of the Median Nerve. Boston, Butterworth-Heineman, 1993. Rowland LP Surgical treatment of cervical spondylotic myelopathy Time for a controlled trial. Neurology 1992 42 5-13. Stewart JD Focal Peripheral Neuropathies. New York, Elsevier, 1987. 27. Gelberman RH, Hergenroeder PT, Hargens AR, et al The carpal tunnel syndrome A study of carpal canal pressures. j Bone Joint Surg 1981 63A 380-383 28. Phalen GS The carpal tunnel syndrome seventeen years' experience in diagnosis and treatment of six hundred fifty-four hands. j Bone Joint Surg 1966 48A 211-248 31. Stevens JC, Sun S, Beard CM, et al Carpal tunnel syndrome in Rochester, Minnesota, 1961 to 1990. Neurology 1988 38 134-138 33. Ross MA, Kimura J American Academy of Electrodiagnostic Medicine case report No. 2 the carpal tunnel syndrome. Muscle Nerve 1995 18 567-573 34. Weiss ND, Gordon L, Bloom T, et al Position of the wrist associated with the lowest carpal tunnel...

Clinical Features And Evaluation

One of the most important diagnoses to make in the athlete with back and leg pain is that of peripheral nerve injury and peripheral nerve entrapment. There is a great variety of peripheral nerve problems ranging from a generalized peripheral neuropathy to carpal tunnel syndrome, pyriformis syndrome, peroneal nerve injury, femoral neuropathy, and interdigital neuroma. The chief reason for performing electromyography and a nerve conduction study of the lower extremities is to diagnose a peripheral nerve problem. The nerve conduction study combined with a careful physical examination can at least raise the distinct possibility of a peripheral nerve problem and heighten the diagnostician's skepticism concerning small, poten

Ulnar Nerve Palsy Handlebar Palsy

Symptoms can take from several days to months to resolve, but surgical treatment is rarely necessary. Rest, stretching exercises, and anti-inflammatory medications usually help relieve the symptoms. Applying less pressure or weight to the handlebars and avoiding hyperextension can help to prevent a recurrence. Other advisable changes include padded gloves, wrist splints, and adjusting the position of the hands on the handlebar.

Distal Radius Fracture

Long term this increases the risk of stiffness and osteoarthritis, leading to long-term wrist pain and loss of function. Given these findings, surgical interventions such as open reduction internal fixation (ORIF), external fixation, or percutaneous pinning are indicated at times.

Cubital Tunnel Syndrome

Also referred to as ulnar nerve entrapment, cubital tunnel syndrome is the second most common nerve compression disorder. (The first is carpal tunnel.) The pathway of the ulnar nerve predisposes it to compressive, traction, and friction forces. The cubital tunnel is found deep to the arcuate, which connects the ulnar and humeral heads of the flexor carpi ulnaris (FCU) muscle. Repeat elbow flexion can cause irritation of the ulnar nerve through this tunnel and lead to nerve irritation and dysfunction.

Clinical Manifestations and Diagnosis

Signs of systemic involvement may also be seen, for example, nodules at the elbows, cutaneous degeneration at the fingertips (which appear as small, 1- to 2-millimeter infarcts in the nail fold) or at the elbow tip, pulmonary fibrosis, inflammation of the sac enclosing the heart, anemia, fever, rash and peripheral ulcers in the lower limbs, disease of the nervous system, and wrist weakness occasioned by the carpal tunnel syndrome. In addition, there is usually a gradual weight loss as well as the loss of muscle volume and power.

Carpal And Carpometacarpal Dislocations Clinical Summary

Another potentially serious injury is scapholunate dissociation, often mistakenly diagnosed as a sprained wrist. Although the physical examination may be unremarkable except for wrist pain, an anteroposterior (AP) radiograph reveals a widening of the scapholunate joint space. This space is normally less than 3 mm. A space of 4 mm or greater should prompt suspicion of disruption of the scapholunate ligament. The lateral radiograph may reveal an increase of the scapholunate angle to greater than 60 to 65 degrees (normal 45 to 50 degrees). All these injuries may present with concomitant fractures of the carpal bones or distal forearm.

Human growth hormone hGH and insulinlike growth factor IGFI

In either untrained or well-trained individuals 11 . What has been shown is an enhancing effect of GH on lipid oxidation and thus on body composition. Growth hormone administration results in several side-effects, in both the short and long term. Immediate side-effects are fluid accumulation in the legs and carpal tunnel syndrome, whereas impaired glucose metabolism (glucose intolerance), hyperlipidemia and car-diomegaly can develop with long-term misuse. IGF-I has become used as a doping substance but no good experiments have documented any major effect of its administration in relation to muscle growth and performance.

Causes of the Creakin

Feeling better Little by little, we'll cover many of the health concerns that you have, and you can even pick up some tips for your friends. So far you've gotten some solid solutions to such nagging complaints as tennis elbow, bursitis, carpal tunnel, and arthritis. You've got stretches, acu-points, and herbs to chew on. What's next Your lower torso awaits to get on the healing path. ) Firm acupressure on L1-12, LI-11, or LI-10 can reduce tennis elbow pain. ) Electro- or laser acupuncture short-circuits carpal tunnel pain and numbness. ) Make an herbal soup to wash away your arthritic pain and stiffness.

Ill Be Back Acupressure Stretch and Press

Margaret Naeser, Ph.D., licensed acupuncturist and associate research professor of neurology at the Boston University School of Medicine, has been using low-energy lasers (5-20 megawatts compared to a typical surgical laser of 300 watts) to treat postsurgical pain from carpal tunnel syndrome. A red beam is all you see on your wrist or hand. You don't feel a thing while you end the zing Margaret Naeser, Ph.D., licensed acupuncturist and associate research professor of neurology at the Boston University School of Medicine, has been using low-energy lasers (5-20 megawatts compared to a typical surgical laser of 300 watts) to treat postsurgical pain from carpal tunnel syndrome. A red beam is all you see on your wrist or hand. You don't feel a thing while you end the zing Relieving carpal tunnel syndrome. Relieving carpal tunnel syndrome. While keeping 3 our arm out straight and 3 our hand in good alignment with 3 our arm, pull straight back to achieve a stead , even, gentle stretch of the...

The Terminator in the Tunnel Acupuncture on the Scene

In traditional Oriental Medical terms, the symptoms of carpal tunnel syndrome reflect cold (a victim often feels more pain with cold), dampness (forearm and hand may feel heavy and achy), and wind (characterizes the tingling or shooting nerve pain) that block the otherwise smooth flow of blood and Qi in our arms. Acupuncture treatments include stimulation of acu-points near the wrist by an in-and-out technique with the needle. You may feel a mild electrical sensation, which is desired because it will help release the tendons and decrease pain and numbness. Acupuncture needles, electroacupuncture, electromagnetic acupuncture, moxibustion, magnet therapy, and even laser acupuncture are successfully used in treating carpal tunnel syndrome.

Trouble in the Tunnel

Symptoms of carpal tunnel syndrome often crop up after you start a new job or a new hobby that forces you to use your wrist and fingers in a repetitive motion. Women are particularly susceptible to developing the condition, especially if they're pregnant or between the ages of 40 and 70. The pain can affect one or both arms and can involve pain in the forearm, wrist, and or palm. Some patients with carpal tunnel feel a sharp pain when they make the repetitive movement, others experience a constant numbness or tingling in the thumb, index, middle, and half of the ring finger. Don't assume it's carpal tunnel syndrome. Other conditions, such as diabetes, alcoholism, wrist fractures, and arthritis of the sixth vertebra in the neck, have similar symptoms. Check with your health professional to rule out these or other conditions. The symptoms often worsen at night, and can get so bad that the patient has to wake up in order to shake his or her hands to relieve the numbness. If you're...

Keeping Pain at Arms Length

- Learn the stretches and catches to combat carpal tunnel When you experience pain in any of the joints of your arms, it makes it hard to do most anything. Most activities become a struggle. With shoulder bursitis, you can hardly comb your own hair. Tennis elbow makes it a challenge to pick up a pot full of water off your stove. Carpal tunnel limits your productivity at work, and arthritis in your hands can seem like an impregnable barrier to any task.

Magnets Whats the Attraction

Tn Oriental Medicine, magnets are used to set up specific patterns of flow, using the bioelectrical and magnetic properties of Qi. Although no one completely understands how they work, practitioners use magnets to treat such conditions as arthritis, back pain, bursitis, carpal tunnel, and tennis elbow.

Other Carpal Fractures

Significant forces transmitted through the wrist from a fall or collision can potentially fracture any of the eight carpal bones. Unlike the previously discussed injuries, the remaining carpal fractures are more straightforward with regards to diagnosis and treatment. Athletes presenting with significant wrist pain, swelling, or deformity require a precise physical examination with palpation of each carpal bone followed by appropriate radiographs. Subtle fractures may be difficult to identify on plain radiographs. Computed tomography can significantly aid in the diagnosis of occult fractures occurring in the setting of wrist pain swelling and negative plain radiographs.

Triquetrum impaction fractures

Fractures of the triquetrum are seen in athletes however, there is no consistent association with any particular sport 3 . They tend to happen as a result of a fall or blunt trauma to the dorsum of the hand. Others have suggested impaction of the triquetrum against the ulnar styloid 3,84 . Patients present with dorsal ulnar wrist pain. Placement of the wrist in the position of dorsiflexion and ulnar deviation will reproduce the

Extensor insertional tenosynovitis

2nd Dorsal Compartment Injection

Tenosynovitis of the extensor pollicis longus can occur and is seen after distal radius fractures in squash or tennis players. The tendon is at risk as it crosses around Lister's tubercle. The patient presents with a history of dorsal radial wrist pain which is elicited with resisted thumb extension. Treatment consists of splinting and NSAIDs. An injection of steroid can be added to the regimen if initial methods fail. In cases resistant to non-operative measures, transposition of the tendon radial to Lister's tubercle can be considered.

Extensor carpi ulnaris tenosynovitis

Extensor Carpi Ulnaris Tenosynovitis

Extensor carpi ulnaris (ECU) tenosynovitis is an uncommon condition seen typically in racquet sports 62,69 . The ECU is notable because of its distinct sheath which crosses the wrist (Fig. 6.7.12) 70 . The ECU is believed to contribute to the stability of the wrist. Patients with ECU tenosynovitis typically present with dorsal ulnar wrist pain and swelling. Examination demonstrates tenderness over the ECU at the

Cushings Syndrome Cushings Disease

The hypersecretion of GH produces various forms of disfigurement and other physical changes ( Ia(, e 3.8.-i 1., ). Central sleep apnea has been reported in one third of acromegalic patients with sleep apnea. W Importantly, the presence of sleep apnea increases the risk for hypertension, myocardial infarction, and stroke, as well as accident susceptibility due to daytime sleepiness. Wi Mononeuropathies, especially compression neuropathies such as carpal tunnel syndrome (CTS), may be noted. CTS occurs in 50 percent of patients and is noted in 75 percent when EMG testing is performed. y Objective weakness, in a myopathic pattern, is observed in about 40 percent of acromegalic patients. 77 The weakness typically has an insidious onset and is a late manifestation, correlating best with the duration of acromegaly. 76 Polyneuropathies, nerve root and spinal cord compression, headaches, and visual changes have also been described. y

Table 304 Mucopolysaccharidoses And Mucolipidoses

Scheie's syndrome usually occurs in individuals of normal size, and their neurological deficits are less severe than those seen in patients with types 1 and 2 disease. These patients have only mild hepatosplenomegaly with marked coarseness of the facial features or severe mental retardation. Dysostosis multiplex or bony involvement is also mild, although a common feature is carpal tunnel symptomatology. It is rare for neurological problems to be severe enough to cause early complaints. Generally, ocular involvement, specifically corneal clouding or retinal abnormalities suggesting degeneration, lead to suspicions of an MPS disorder. In most instances, the diagnosis is not made before the age of 10 years, and frequently it is not recognized until age 20 or later.

Supranuclear Syndromes

Facial sensory loss may occur in the setting of lesions involving the trigeminothalamic pathways, corona radiata or internal capsule white matter projections from the VPM nucleus of the thalamus to primary sensory cortex, or within sensory cortex itself. Specific pathological processes affecting these pathways include ischemia, hemorrhage, neoplasm, and demyelinating diseases. All result in contralateral hemifacial and hemibody numbness. In seizures, facial tingling often occurs in association with hand numbness and suggests a lesion in the postcentral gyrus. In the cheiro-oral syndrome, ipsilateral numbness in the hand and at the corner of the mouth reflects an insult, typically vascular, at adjoining portions of the ventroposterolateral and VPM nuclei of the thalamus where the anatomical distributions of these regions are directly adjacent to one another. In contrast, a persistent deep, aching, poorly localized facial pain has been reported in patients with thalamic lesions...


A 28-year-old woman is diagnosed with carpal tunnel syndrome. Which of the following tendons course through the carpal tunnel 20. Which of the following fascial layers forms the roof of the carpal tunnel 22. Compression of the median nerve in the carpal tunnel results in weakness in the thenar muscles and the first and second lumbricals. In which of the following areas would the patient most likely experience cutaneous deficits

Patient Satisfaction

Testing of patient satisfaction has become an integral part of rehabilitation endeavors. Just as other test instruments must meet instrumentation criteria, so too must patient satisfaction assessment tools meet these criteria. Satisfaction surveys are often in the form of patient-completed questionnaires. Current symptom satisfaction tools that are used in evaluating patients with upper extremity injury or dysfunction include the Medical Outcomes Study 36-Item Health Survey (SF-36),10 the Upper Extremities Disabilities of Arm, Shoulder, and Hand (DASH),5 the Michigan Hand Outcomes Questionnaire (MHQ),18,19 and the Severity of Symptoms and Functional Status in Carpal Tunnel Syndrome questionnaire.10,37 10. Bessette L, Keller RB, Lew RA, et al Prognostic value of a hand symptom diagram in surgery for carpal tunnel syndrome, J Rheumatol 24(4) 726-34, 1997. 37. Levine DW, Simmons BP, Koris MJ, et al A self-administered questionnaire for the assessment of severity of symptoms and...

Scapholunate Sprains

Self Administered Hand Diagram

Patients with a simple scapholunate sprain require protection and rest with a period of splinting. This can be accomplished with a custom fiberglass or plaster splint, or a prefabricated cock-up wrist splint until the patient is asymptomatic. After initial treatment, the patient is weaned from the wrist splint and begins active ROM and hand-strengthening therapy. In patients with scapholunate dissociation, surgical consultation should be considered early, and referral to a hand specialist is encouraged. Fixation of the joint is often needed to maximize future wrist function (Fig. 30-23).

Informed Consent

The requirement to obtain informed consent applies to anyone doing genetic testing. It is not limited to physicians. The EEOC brought suit against Burlington Northern and Santa Fe Railway193 for doing genetic tests on employees for markers linked to carpal tunnel syndrome without their knowledge or consent. Subsequently, the company stopped doing the testing and agreed to a settlement with the employees.


In contrast, the flexor tendons glide in synovial sheaths at the wrist, palm, and digits and therefore may be affected in any of those areas. Volarly, tenosynovitis at the wrist may compress the median nerve, leading to carpal tunnel syndrome. When the palm and digits are involved, limited active motion or digital triggering or locking may result.

Hook Of The Hamate

The hamulus, or hook of the hamate, protrudes into the palm surrounded by critical soft-tissue structures. The hook serves as the origin of the flexor and opponens digiti minimi muscles and forms the ulnar border of the carpal tunnel and radial border of Guyon's canal.1 The deep motor branch of the ulnar nerve courses around the base of the hook with the superficial sensory branch remaining in close contact with the tip. The hook also functions as a pulley for the superficial and deep flexor tendons to the small and ring fingers, especially during ulnar deviation involved with power grip. Therefore, fracture and or fracture nonunion of the hook of the hamate jeopardize injury to any or all of the previously mentioned structures. Early diagnosis is critical to successful management of hook of the hamate fractures. The majority of these injuries will proceed to nonunion if left untreated.20 Fracture nonunion predisposes the athlete to (1) chronic ulnar-side wrist pain, (2) ulnar nerve...


Gymnastics is a common cause of wrist problems in athletes. It has been estimated that between 46 and 80 of elite gymnasts develop wrist pain at some time in their career 11 . This is due to the conversion of the upper extremity to a weight-bearing limb in gymnasts. The position and mechanism in these types of injuries are dorsiflexion and compression in nearly all gymnastic events 12 .


Back pain is one of the most frequently reported health problems. It ranks second only to the common cold as a reason for doctor's office visits in the U.S. Low back pain is the most common problem brought to chiropractors, although headache, shoulder pain, neck pain, sports and workplace injuries, tension, and carpal tunnel syndrome (pain, weakness, numbness, or tingling in the arm or hand) also are frequently treated by chiropractors.

Nerve Supply

Sehnen Daumen

Fig. 2-24 Cross sectional anatomy of the carpal tunnel shows its anatomic boundaries. The carpus and the palmar roof formed by the transverse carpal ligament are shown, as is the position of the median nerve. An increased volume in this passageway most frequently resulting from thickening or inflammation around the nine flexor tendons can result in compression of the median nerve and the condition known as carpal tunnel syndrome. Fig. 2-24 Cross sectional anatomy of the carpal tunnel shows its anatomic boundaries. The carpus and the palmar roof formed by the transverse carpal ligament are shown, as is the position of the median nerve. An increased volume in this passageway most frequently resulting from thickening or inflammation around the nine flexor tendons can result in compression of the median nerve and the condition known as carpal tunnel syndrome. A number of entrapment phenomena are now recognized that may cause complete or partial paralyses, purely sensory deficits, or a...


Lipomas, also known as lipofibromatous hamartomas or neural fibrolipomas, are benign tumors arising from the proliferation of adipose or fibrous tissues. Grossly, they are well circumscribed and encapsulated and have a fusiform and yellowish appearance in the subcutaneous layer.92 Histologically, lipomas can be intimately associated with functioning nerve fibers from which they cannot be easily separated. The median nerve is most commonly affected. Larger lipomas can envelop, infiltrate, or compress important nerves such as the brachial plexus when located in the supraclavicular fossa.61 Overall, lipomas are the most common soft-tissue tumors in adults, occurring in 1 out of 1000 individuals.131 They occur mostly in children or during early adulthood. Treatment includes biopsy of the tumor and decompression of the involved nerve when it becomes entrapped by surrounding structures such as the carpal tunnel. Complete resection of these tumors when involving a nerve is usually not...

Clinical Trials

Physical therapies aim to improve postural alignment during gait and sitting to place muscles in an optimal position for contractions. Gait deviations are improved with orthotic and assis-tive devices that decrease the energy cost of am-bulation. Therapists can also treat soft tissue and joint sources of pain. Assistive devices and splints can reduce pain and lessen overuse of the weak upper extremities. Pain from carpal tunnel syndrome associated with use of a cane or wheelchair can often be treated with a wrist splint. Work and home modifications and support groups are especially valued by persons with PPS.


A thermoplastic wrist splint is made with careful attention to curves in molding the palmar eminence and metacarpal arch, to provide anatomic support and splint strength (Fig. 23-2). The distal thumb and metacarpophalangeal (MP) crease edges can be folded and add to strength with minimal coverage. Tongue extensions (radial and ulnar deviation bars) around the thumb web space and at the ulnar border of the metacarpals add to splint stabilization on the arm during active use of the prosthesis. The forearm portion is made approximately three-quarters of the forearm, with an ulnar tongue wrapping around onto the dorsal forearm for a cable attachment. The final splint mold should allow the patient's forearm and hand to slide in and out easily. It should also allow full forearm pronation and supination (Fig. 23-1).

Chronic Pain

Pain after SCI arises from contractures, osteo-porotic fractures, extensor spasms, soft tissue injury, musculoligamentous strain, myofascial pain, and inflammation of tendons and bursas, especially from overuse of the upper extremities. Current pain is reported by up to 80 of people with SCI. Common locations include the back (60 ), hip and buttocks (60 ), and legs and feet (58 ).86 In a community survey, pain limited participation in ADLs and IADLs for 2 weeks out of the previous 3 months. Chronic pain interferes with sleep in approximately 40 of people who experience it.87 In another survey of 450 SCI patients, 72 reported chronic pain in the wrists or shoulders, especially during wheelchair propulsion and transfers.88 Strain and cumulative trauma appeared to be the cause. Painful compression neuropathies like a carpal tunnel syndrome increase over time in patients with paraplegia who bear weight through the upper extremities for wheelchair propulsion. Wheelchair modifications such...

Ulnar Nerve

The ulnar nerve courses posteriorly to the medial epicondyle of the humerus in the osseous groove, into the anterior compartment of the forearm between the two heads of the flexor carpi ulnaris muscle (Figure 32-3B). The ulnar nerve continues through the anterior compartment of the forearm supplying only two muscles, the flexor carpi ulnaris and the ulnar half of the flexor digitorum profundus. Proximal to the wrist, the ulnar nerve gives rise to two cutaneous branches, a dorsal branch and a palmar branch, which provide cutaneous innervation to the dorsal medial side of the hand and the medial side of the palm, respectively. The ulnar nerve continues into the hand superficial to the carpal tunnel and courses through Guyon's canal by the pisiform bone to enter the hand.

DeQuervains Disease

Symptoms include wrist pain with use and localized edema. Definitive testing for deQuervain's involves elicitation of a positive pain response when the thumb is passively held in flexion and the wrist is adducted (Finkelstein's test). To decrease tendon glide of the EPB and APL, a wrist extension, thumb CMC palmar abduction and MP flexion immobilization splint, type 0 (3) is fitted to immobilize the wrist and thumb in a position of rest. The wrist is positioned in approximately 15 extension or dorsiflexion, the thumb CMC joint in 40 palmar abduction, and the thumb MP joint in 10 flexion (Fig. 17-17). The thumb IP joint is not incorporated in the splint since neither the EPB nor APL traverses this joint. Accompanying exercise regimes and modality use are dependent on individual therapist and physician preferences. Throughout the immobilization phase, it is important that therapist and patient work together to analyze and modify the patient-specific...

Wrist Finger Splints

According to the most proximal primary joint(s), these splints are classified as wrist splints even though the splints affect both carpal and digital articulations. In contrast, when the wrist is considered a secondary joint and digital joints are primary joints, the splint is classified as a finger or thumb splint accordingly. With the exception of the torque transmission splints that fit in this general category, primary wrist and digital splints tend to be highly individualized, one-of-a-kind designs allowing personalized solutions to uniquely differing pathology.


Tendon Gliding For Quervain

De Quervain's disease involves a stenosing tenosynovitis of the first dorsal wrist compartment, which contains the abductor pol-licis longus and the extensor pollicis brevis. Patients often present with radial side wrist pain that is worsened with movement of the thumb. It is more common in the fourth and fifth decades and in females. Patients often report a history of repetitive activities involving thumb abduction and ulnar deviation of the wrist. On physical examination, Finkelstein's test will be positive (Fig. 40-9). This test is performed by fully adducting the thumb and then the wrist, which will reproduce the patient's pain. The differential diagnosis includes intersection syndrome and carpometacarpal arthritis. Patients with intersec- Intersection syndrome is a stenosing tenosynovitis of the second extensor compartment. Patients often report radial side wrist pain 4 cm proximal to the wrist joint. This syndrome is often found in lifting and rowing athletes. On physical...


All of the nerves that travel to the hand cross the wrist. Three main nerves begin together at the shoulder the radial nerve, the median nerve, and the ulnar nerve. These nerves carry signals from the brain to the muscles that move the arm, hand, fingers, and thumb. The radial nerve provides sensory innervation to the dorsum of the hand, thumb, index, middle, and part of the ring finger. The median nerve enters the hand through the carpal tunnel and provides motor and sensory innervation to

Pronator Syndrome

And increased pain with resisted pronation are also consistent with this diagnosis. Athletes with pronator syndrome have difficulty touching the tips of the first and second fingers to make a circle (the OK sign). This is consistent with weakness in the median nerve distribution. Specifically, motor loss is noted in decreased ability to pronate and flex the wrist as well as partial loss of finger flexion and loss of thumb opposition. A key distinguishing feature between pronator syndrome and carpal tunnel syndrome is the decreased sensation over the thenar eminence that is unique to pronator syndrome. This is because the sensory branch of the median nerve (palmar cutaneous branch) innervating the thenar eminence does not pass through the tunnel. As probably suspected, electrodiagnostic testing can provide evidence for the diagnosis of pronator syndrome.

Disabled Athletes

Athletes with spinal cord injuries have their own set of medical concerns. For example, shoulder injuries and carpal tunnel syndrome are very common among the wheelchair-dependent population. Exercises that strengthen the rotator cuff and scapular stabilizers should be initiated early. Also, paralyzed athletes can accumulate fluid in the immobilized extremities during physical activity, which diminishes cardiac return and cardiac output. These individuals should be advised to use compressive garments during exercise. Paraplegic athletes with high thoracic injuries (above the T6 neurological level) have problems regulating body temperature and should be advised to avoid exposure to severe environments. There are also skin issues of potential concern, such as pressure sores, and persistent fungal infections which must be identified and addressed.


Athletes present with pain localized to the radial side of the wrist either following an acute trauma or, not uncommonly, at the conclusion of the athletic season. Often, the athlete provides a history of recurrent, nagging wrist sprains. Clinical and radiographic evaluation must be systematically performed to identify the presence of a scaphoid fracture and define the parameters known to guide appropriate treatment and affect long-term outcomes. Paramount to this endeavor is a high index of suspicion for scaphoid fracture in any athlete presenting with radial-side wrist pain. History centers on (1) the acute event, with emphasis placed on the timing and energy of injury and (2) history of upper extremity trauma or wrist pain swelling. Time from injury to presentation has significant implications with regard to success of treatment and length of time to fracture union. Several studies have documented substantially increased risk of delayed healing and nonunion in fractures where...

Wrist and hand

Depending on the history and basic examination, specific tests can be added. With nerve entrapment there is usually projecting pain and numbness in the sensory area of the nerve when the examiner taps with a finger in the entrapment area (Tinel's sign). With carpal tunnel syndrome, Phalen's sign is usually positive with the wrist flexed for 60 s, pain and paresthesia in the median nerve area is elicited, and reversed when the wrist is put in the neutral position. Tendon inflammation is painful on direct palpation but also when the tendon is used, especially against resistance. Finkelstein's test is positive with tenosynovitis in the abductor pollicis longus extensor pollicis brevis at the radial styloid process the patient is asked to make a fist with the thumb in the palm. The examiner adds passive ulnar deviation of the hand, which is very painful.

Wartenbergs syndrome

Any sport which requires repetitive forearm rotation and ulnar deviation of the wrist can lead to traction neuropathy of the superficial branch of the radial nerve. This condition is common in non-athletes as well. The nerve can be found located in a subcutaneous position between the extensor carpi radialis longus and the brachioradialis in the mid-distal forearm. As the nerve continues distally to the wrist, the brachioradialis and extensor carpi radialis muscles transition from muscular to tendinous portion and this is where the location of entrapment occurs. Patients complain of pain and numbness over the dorsal radial aspect of the hand and thumb. Physical examination includes Tinel's sign over the nerve with reproduction of symptoms in wrist flexion and ulnar deviation 3 . Treatment includes cessation of aggravating activities, ice, and splinting in a cock-up wrist splint. If these measures are not successful in alleviating symptoms the nerve can be released over the point of...

Nerve disorders

Nerve disorders can be common in certain athletic endeavors such as cycling, baseball, karate, rugby and handball 3 . Problems in these athletes may include carpal tunnel syndrome, cyclist's palsy, gymnast palsy and Wartenberg's syndrome. The cause of these disorders is believed to be mechanical compression secondary to local tissue edema, blunt trauma, adjacent joint synovitis or equipment constraints which results in compression and vascular compromise of the nerve. This mechanical compression causes venous obstruction and subsequent congestion, resulting in anoxia. This anoxia results in greater edema and an inflammatory response, with the end result being fibroblastic proliferation and constriction of the nerve 3 .

Gymnasts wrist

The popularity of gymnastics has increased over the past two decades. There are often overuse injuries at the level of the wrist associated with gymnastics 12 . Chronic repetitive compressive forces on the distal radius have adverse effects on enchondral ossification. Repeated microtrauma may disrupt the metaphyseal vascular network. This may result in a wide and irregular physis 3 . Patients will present with a prolonged history of dorsal wrist pain that is exacerbated by activities and may also have local swelling over the wrist. X-rays in this condition will show widening of the distal radial physis and cystic changes and irregularity of the metaphyseal margin of the physis and palmar radial beaking adjacent to the physis and haziness of the physis 3,87 . This process is thought to be a result of extreme dorsiflexion. The treatment consists of cessation of aggravating activities and weight-bearing on the affected extremity should not be resumed until the patient is asymptomatic 3 .

Cse story 672

A patient with a scaphoid fracture will complain of pain on the radial aspect of the wrist. Pressure over the volar tubercle on the scaphoid will result in pain. Also, palpation of the snuff box area between the first and third dorsal compartments will result in discomfort. Radiographs will usually demonstrate a displaced fracture, however, many scaphoid fractures are initially non-displaced. Suspicion should be raised if an athlete falls onto the wrist and he presents with chronic wrist pain. A bone scan, tomogram, or CT scan may demonstrate a fracture of the scaphoid, even if the plain radiographs are nor

Subjective Objective

Hypothyroidism its reported incidence among adult hypothyroid patients varies. y Minor evidence of polyneuropathy, such as distal lower extremity sensory dysfunction and absent ankle jerks, is observed in approximately 10 percent of patients, y and rarely, a moderately severe sensorimotor polyneuropathy has been described. Carpal tunnel syndrome (i.e., median mononeuropathy at the wrist) occurs in 15 to 30 percent of hypothyroid patients, is usually bilateral, and is the most common mononeuropathy encountered.


Paresthesias and diffuse weakness in the upper extremity. Recurrent stretch injuries to the brachial plexus can result in permanent weakness and atrophy. Also, apical lung tumors with direct extension or compression can cause pain in the upper extremity and hand numbness. Radiation therapy also can result in brachial plexopathies. Idiopathic brachial plexopa-thy (Parsonage-Turner syndrome) often occurs abruptly without any clear precipitating factor, although it can develop after an infection, injection, surgery, or childbirth. It typically begins with an aching sensation in the neck or shoulder and progresses over days to produce weakness, sensory loss, and diminished reflexes. Patients with brachial plexopathy often have considerable pain. Recovery is usually spontaneous but can take weeks to months. Some residual weakness may be present in a few patients.

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