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Distinction between carpal tunnel syndrome and de quervain tenosynovitis

Carpal tunnel syndrome

Definition

Median nerve that runs through in the carpal tunnel gets compressed

Median nerve originates from C5,6,7,8 and T1 and enters the arm from inferior part of trees major, passes through anterior compartment of the arm, runs through cabital fossa then goes forearm through carpal tunnel through first to third and half of forth finger.

Aetiology

  • Repetitive flexion and extension
  • Diabetes due to fluid retention
  • Smoking
  • Pregnancy
  • RA
  • Overuse of the hand and wrist

Sign and Symptoms

Usually occurs unilateral and dominate hand

Women>men Commonly ages 40-60

  • Numbness, pins and needles sensation in thumb, index and middle finger as median nerve distributes.
  • Condition gets worse at night and relieves by shaking the hand.
  • Loss of colour (Ischaemia) in the area

Treatment

  • Splinting or supporter to avoid moving and prevent the wrist from flexing  at night
  • Oral anti-inflammation
  • Steroid or surgery if it is severe
  • For practitioners, to reduce oedema, inflammation, the muscle tension on arms and shoulder by hands on techniques such as lymphatic drainage, MFR and trigger points.
  • Muscles need to be worked on are wrist flexors apart from ulnaris, pronator, biceps, brachial and coracobrachialis.
  • ICE and Give them strength trainings and home-stretching

Orthopedic test to identify Carpal tunnenl syndrome

De Quervain’s tenosynovitis

Definition

De Quervain’s tenosynovitis affects the tendon at the base of the thumb and pain at the base of the thumb and spread into hand and forearm. It affects abductor pollicis longus and extensor pollicis brevis tendon which pass through the first dorsal compartment of the wrist. *2

Aetiology

  • Excessive flexion and extension, and rapid rotation of the wrist
  • Strain of abductor pollicis longus and extensor pollicis brevis
  • Jobs or sports require radial and ulna deviation such as golf and carpenter  

Sign and symptoms

  • Worse in the morning because of blood accumulation in the thumb of fingers
  • Holding and pinching something with thumb and other fingers
  • Pain when play golf, lifting a child and hammering a nail

Orthopedic test to identify De Quervain’s tenosynovitis

Trigger finger

 Trigger finger is the condition where the sheath of the finger is affected

It is difficult for people who have this condition to extend the fingers fully or make a fist

Aetiology

Repetitive motion and occupations with fingers bent such as musician, factory workers and people who sewing and knitting

Treatment

  • Splint to stabilise the fingers, hands and arms at night for carpal tunnel for both conditions using it at night tight is for carpal tunnel syndrome.
  • Massage on wrist flexors, extensors and shoulder as some shoulder muscles pain patters are referring to hands and fingers

Reference

  1. Somaiah Aroori and Roy AJ Spence Carpal tunnel syndrome 2008 Ulster Med J 77 (1):6-17
  2. Ritu Goel and Joshua M Abzug de Quervain’s tenosynovitis: a review of the rehabilitative options 2015 10 (1):1-5

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