Thursday, August 11, 2022

How Would You Evaluate An Athlete For Carpal Tunnel Syndrome

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Can This Injury Or Condition Be Prevented

How Do I Know If I Have Carpal Tunnel Syndrome?

There is no single proven strategy for preventing CTS, but there are ways to reduce stress to your hands and wrists. Since there are several factors that can contribute to developing CTS, one single solution may not be effective.

The following are effective ways to decrease stress to your hands and wrists:

Evaluation Of A Comprehensive Telemedicine Pathway For Carpal Tunnel Syndrome: A Comparison Of Virtual And In

This article was originally published here

J Hand Surg Am. 2021 Oct 28:S0363-502300599-2. doi: 10.1016/j.jhsa.2021.08.024. Online ahead of print.


PURPOSE: We evaluated a comprehensive telemedicine pathway for carpal tunnel syndrome . Our primary aim was to compare telemedicine and in-person administration of the six item CTS-6 instrument in patients undergoing carpal tunnel release and to determine whether surgical plans determined via telemedicine were altered by in-person assessments. We additionally aimed to assess agreement between telemedicine and in-person examinations.

METHODS: In this prospective investigation, patients referred to a hand surgeon for evaluation of CTS were offered a telemedicine pathway. A modified, virtual CTS-6 was administered during the telemedicine consultation and a virtual exam was performed. Patients indicated for CTR were evaluated in person on the day of surgery. Agreement between the telemedicine and in-person CTS-6 and exam findings was determined. Patients were evaluated via telemedicine postoperatively to determine satisfaction with the program and assess surgical complications.


Evaluation Of Elbow Pain In Adults

SHAWN F. KANE, MD JAMES H. LYNCH, MD, MS and JONATHAN C. TAYLOR, MD, Womack Army Medical Center, Fort Bragg, North Carolina

Am Fam Physician. 2014 Apr 15 89:649-657.

Determining the underlying etiology of elbow pain can be difficult because of the complex anatomy of this joint and the broad differential diagnosis. As with other musculoskeletal problems, the keys to diagnosing elbow pain are a history to include mechanism of injury or exacerbating movements, and a focused physical examination. The patient’s occupation and recreational activities can be important clues to diagnosis. Table 1 provides the differential diagnosis of elbow pain by anatomic location.


If an ulnar collateral ligament injury is suspected, the medial joint space of the symptomatic elbow should be compared with the asymptomatic side for the amount of opening, the subjective quality of the end point while a valgus force is applied across the joint, and pain.

A = consistent, good-quality patient-oriented evidence B = inconsistent or limited-quality patient-oriented evidence C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to .


Differential Diagnosis of Elbow Pain Based on Anatomic Location


Radial tunnel syndrome/posterior interosseous nerve syndrome



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Managing And Treating Carpal Tunnel Syndrome In Athletes

    Carpal tunnel syndrome is the most common peripheral neuropathy in sports medicine. Its a condition that occurs when the median nerve becomes pressured or squeezed at the wrist a junction known as the carpal tunnel. The mechanism of injury varies, but its rarely to do with the median nerve itself and instead down to pressure on the nerve from inflammation of the ligaments and tendons surrounding the nerve, forcing them to put pressure on it .

    In this article were going to look at the problem, its association with athletes and how best to manage the condition.

    Time to read: 5 minutes

    Level: Intermediate

    • The Causes of the Syndrome in Athletes
    • How Does Carpal Tunnel Syndrome affect Sporting Performance
    • How Can Athletes Treat and Manage Carpal Tunnel Syndrome
    • How KYMIRA can help with Carpal Tunnel Syndrome

    Research And Possible Risk Factors

    News &  Information Blog

    Researchers have found that a previous wrist fracture and the use of insulin, metformin, and sulphonylureas are associated with a higher chance of CTS. Smoking, hormone replacement therapy , the combined oral contraceptive pill, and oral corticosteroids did not appear to be not linked to a higher risk of CTS.

    One study has suggested that obesity, combined with a square-shaped wrist shape, may increase the likelihood of CTS developing. However, the team concluded that obesity was probably not the cause, because when participants with obesity lost weight, they continued to have CTS.

    The same team concluded in other research that the age of women at the menopause might be a factor, and that pregnancy-related hormones may increase the risk of CTS in women at the time of the menopause.

    Postmenopausal women who use aromatase inhibitor drugs for breast cancer often experience CTS.

    Apart from work-related factors, the main risk for CTS is inflammatory arthritis, but hypothyroidism and diabetes also appear to increase the chance of developing it, according to research published in the Journal of General Internal Medicine.

    The National Institute of Neurological Disorders and Stroke says that CTS is three times more likely to occur among people working in assembly operations than in data-entry personnel.

    The Canadian Centre for Occupational Health and Safety list the following occupations as risk factors for CTS:

    According to the National Library of Medicine, there is

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    How To Reduce Carpal Tunnel Syndrome Through Diet And Healthy Habits

    Carpal tunnel syndrome is a rising concern as more people work on computers, which requires repetitive motion. In addition to office workers, people working assembly line jobs, janitors, painters and cashiers are often at risk for symptoms of carpal tunnel due to the repetitive nature of their work. Fortunately, symptoms and pain may be reduced or cured by changes in diet and adjustments to habits or work activities.

    Examination Activity Limitations/physical Impairment Measures

    Strength Measures

    Clinicians should not use lateral pinch strength as an outcome measure for patients with nonsurgically or surgically managed CTS.

    Clinicians should not use grip strength when assessing short-term change in individuals following CTR surgery.

    Clinicians may assess grip strength and 3-point or tip pinch strength in individuals presenting with signs and symptoms of CTS and compare scores with established norms.

    There is conflicting evidence on the use of tip and 3-point pinch strength and abductor pollicis brevis muscle strength testing in individuals following CTR surgery.

    Sensory and Provocative Measures

    Clinicians should not use threshold or vibration testing to assess change in individuals with CTS undergoing nonsurgical management until more evidence becomes available. Clinicians may use the Phalen test to assess change in those with CTR surgery at long-term follow-ups.

    There is conflicting evidence on the use of sensory measures, including 2-point discrimination and threshold testing, to assess change over time in patients with surgically managed CTS.

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    Examination Activity Limitations/physical Performance Measures

    Clinicians may use the Purdue Pegboard or the Dellon- modified Moberg pick-up test to quantify dexterity at the onset of treatment and compare scores with established norms. Clinicians should not use the PPB test, Jebsen- Taylor Hand Function Test, or the Nine-Hole Peg Test to assess clinical change following carpal tunnel release surgery. Clinicians may use the DMPUT to assess change following CTR surgery.

    Professional Collegiate Amateur & Everyday Athletes

    What Is Carpal Tunnel Syndrome? | UPMC

    Are you tired of nagging injuries that affect your athletic training? Does your injury keep returning or is it slow to respond to traditional types of care? Chiropractic Performance Solutions specializes in treating a broad range of common and not-so-common sport injuries. Our goal is not only to eliminate your pain, but to address the underlying biomechanical origin of your injury. A comprehensive evaluation helps guide Dr. Karl to select the appropriate treatment methods to resolve your individual needs quickly and cost effectively.

    Active Release Technique, MLS Laser Therapy, Kinesio taping, Massage Therapy and Chiropractic are just a few of the treatment options used for some of these common injuries:

    • Back Pain

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    Foods That Help Prevent And Alleviate Carpal Tunnel Syndrome

    Adding some of these foods may help reduce symptoms or even prevent carpal tunnel syndrome:

    Vegetables With Bright ColorsVegetables that are bright green or red often contain large amounts of antioxidants for reducing swelling. Dark leafy greens, red or yellow peppers, carrots, red tomatoes and bell peppers are great sources of antioxidants.

    SalmonAdding salmon or other cold water fatty fish to your diet can help reduce carpal tunnel symptoms and inflammation. Consider sardines and tuna, which are high in healthy fatty acids.

    PineappleTropical pineapple contains bromelain enzymes that help to reduce swelling. In addition, coconut, cherries and blueberries contain large amounts of antioxidants to fight inflammation.

    WalnutsWalnuts contain omega-3 fatty acids, just like some types of fish, which can help to reduce swelling. Chia seeds or flax seeds also contain fatty acids.

    SpinachResearch has shown that vitamin B6, found in spinach, is extremely effective for carpal tunnel symptoms. B6 is also found in cantaloupe, cauliflower, bananas, oranges and chicken.

    At Different Disease Stages

    Functional rehabilitation requires mobility, stability, sensitivity, and freedom from pain. Coordinated management can effectively address these needs during different phases of recovery. During the inflammatory phase, edema and pain reduction edema are essential. Control of edema can be achieved through splinting, compression, ice, elevation, and electrotherapeutic modalities. In the regenerative phase, there is a proliferation of scar tissue. Therapists can use supportive splints and active exercises to maintain range of motion. In the remodeling phase, dynamic and serial splints, as well as active assist exercises in addition to heat, stretching, and electrotherapeutic modalities are employed.18, 21, 46

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    Radial Tunnel Syndrome And Posterior Interosseous Nerve Syndrome

    There is some controversy about whether radial tunnel syndrome and posterior interosseous nerve syndrome are two separate entities or a continuum of the same condition. A small percentage of patients who present with lateral elbow pain and are thought to have lateral epicondylitis on initial presentation actually have an entrapment neuropathy of the radial nerve.15,23

    For both syndromes, patients typically present with a history of repetitive forearm supination and pronation and have insidious, poorly localized pain in the forearm. Physical examination typically reveals a positive Tinel sign at the radial tunnel. The point of maximal tenderness usually resides over the anterior radial head. The presence of weakness with resisted supination of the forearm and extension of the middle finger is common with posterior interosseous nerve syndrome 20 . In contrast, radial tunnel syndrome typically presents as a pure pain syndrome without any objective clinical muscular weakness.15,19,23

    Figure 7.

    With the middle finger test, the patient attempts to resist a downward applied force to the fully extended middle finger.

    Figure 7.

    With the middle finger test, the patient attempts to resist a downward applied force to the fully extended middle finger.

    Scope And Organization Of The Guideline

    Treat Carpal Tunnel Without Surgery

    This guideline includes information related to incidence, prevalence, anatomy, pathoanatomy, clinical course, risk factors, diagnosis, outcomes assessments, and interventions for CTS. Where appropriate, sections contain a summary or evidence synthesis and a statement describing gaps in knowledge. Grades of recommendation have been provided for areas related to clinical practice, including diagnosis, outcomes assessment, and interventions. The use of and recommendations for specific diagnostic tests, such as nerve conduction studies, electromyography, magnetic resonance imaging, and ultrasonography, are beyond the scope of this guideline and could serve as future CPG topics.

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    What Is Carpal Tunnel Syndrome

    CTS is typically caused by excessive fluid retention in the wrist, or by repetitive movements like writing, driving, sewing or keyboarding that compress the median nerve. The median nerve runs from the elbow region and through a narrow opening in the wrist, known as carpal tunnel. Any type of swelling or pressure can affect carpal bones or tendons in this region, which ultimately affects the use of wrists and some fingers.

    Physical Therapy After Surgery

    If the evaluation reveals that your CTS is more severe, or if your symptoms persist, your physical therapist may refer you to consult with a surgeon. If surgery is needed, the surgeon will release the band of tissue that forms the roof of the carpal tunnel. This will decrease the pressure on the median nerve.

    Physical therapy treatment is important after surgery to:

    • Prevent scar tissue formation.
    • Help restore strength to the wrist.
    • Help you learn to change habits that may have led to symptoms in the first place.

    Your physical therapy treatment after surgery may include:

    • Scar management to keep the skin supple and flexible.
    • Exercises to glide the nerve within the healing tunnel.
    • Stretching exercises to improve mobility of the wrist and fingers and improve function.
    • Strengthening exercises to improve the strength of the wrist and hand muscles and improve function.
    • Education about proper posture and wrist position to avoid carpal tunnel compression in home/leisure activities.
    • A work site visit or mock-up to show you proper workstation set-up. This can help with posture and positions to prevent CTS from recurring. It also can reduce your risk for developing other nerve injuries.

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    How Is Carpal Tunnel Syndrome Diagnosed And Treated

    A physician will ask the athlete specific questions about symptoms and perform a careful physical examination looking for damage to the nerve. A sports medicine physician will evaluate factors that may make the athlete more prone to getting the condition. He or she may recommend changes specific to the athletes activity, like frequent hand repositioning, using a different racquet for tennis players, changing golf swing technique for golfers, or changing handlebar positions for cyclists. Simply adding padding may also help. Treatment typically involves rest further medical intervention is often unnecessary. Wrist splints may be worn at night to help with nerve healing. However, if symptoms persist for more than two weeks, or worsen, individuals should consult a medical professional for further evaluation. Although symptoms are rarely permanent, if numbness or weakness of the hand has developed, recovery can take a long time. Injections or surgery may be indicated in more severe cases.

    • 5/5

    What Kind Of Physical Therapist Do I Need

    Carpal Tunnel Syndrome Exercises

    All physical therapists are prepared through education and experience to treat a variety of conditions, including CTS. However, you may want to consider:

    • A physical therapist who is experienced in treating people with arm and hand disorders and one who has experience in ergonomics and work site evaluations. Ergonomics involves understanding the fit between the person, their equipment, and their environment.
    • A physical therapist who is a certified hand therapist, or CHT.
    • A physical therapist who is a board-certified clinical specialist or who has completed a residency or fellowship in orthopedic physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

    You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

    General tips when you are looking for a physical therapist:

    • Get recommendations from family, friends, other health care providers.
    • When you contact a physical therapy clinic for an appointment, ask about the physical therapistâs experience in helping people with CTS.
    • Be prepared to describe your symptoms in as much detail as possible, and describe what makes your symptoms worse.

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    Hook Of The Hamate Fractures

    Hamate fractures are uncommon and represent 24% of all carpal fractures . Fractures involving the hook are the most common type of hamate fracture . The incidence of hook of the hamate fractures among professional and recreational athletes is much higher than in the general population and is posited to be on the rise owing to the increasing popularity of golf and racket sports . Several mechanisms cause hook of the hamate fractures, including blunt trauma, repetitive microtrauma, and avulsion injury. Fall on an outstretched hand, motor vehicle collision, and direct strike from a projectile such as a baseball are common causes of acute traumatic fracture . Gripping-related acute trauma to the hook when holding a bat, racket, golf club, or bicycle handle is an additional common mechanism . Stress fractures occur as a result of ongoing repetitive microtrauma from gripping a bat, racket, or golf club . Avulsion fractures occur as the result of ligamentous or tendinous forces tugging on the hook .

    Two patients with sports-related hook of hamate fractures

    A, 21-year-old male baseball player with acute medial wrist pain while batting in game. Carpal tunnel radiograph shows acute nondisplaced transverse fracture at base of hook.

    B, 21-year-old male lacrosse player with gradual onset of wrist discomfort over several weeks without blunt trauma. Axial CT image shows nondisplaced transverse stress fracture near base of hook.

    22-year-old man injured in dirt bike accident

    Evaluation And Treatment Of Carpal Tunnel Syndrome

    Disclosure Statement:

    Financial: Jamie L. Bergner is an instructor for the International Academy of Orthopedic Medicine â US, Hand and Upper Extremity Track. She receives compensation from MedBridge for this course. There is no financial interest beyond the production of this course. Nonfinancial: Jamie L. Bergner has no competing nonfinancial interests or relationships with regard to the content presented in this course.

    Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

    MedBridge is committed to accessibility for all of our subscribers. If you are in need of a disability-related accommodation, please contact. We will process requests for reasonable accommodation and will provide reasonable accommodations where appropriate, in a prompt and efficient manner.

    Video Runtime: 81 Minutes Learning Assessment Time: 25 Minutes

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    Are You At Risk

    Everyday activities may increase your risk for carpal tunnel syndrome.

    • Sewing
    • Golf, Tennis, Racquetball
    • Playing certain musical instruments

    Treatment for carpal tunnel syndrome ranges from activity modification, splinting, and injection for the less severe cases to surgery in the more severe cases. In some cases, a comprehensive hand therapy program can relive the painful symptoms of carpal tunnel syndrome. Your physician or surgeon may request a special test called an EMG to evaluate the function and degree of damage to the median nerve prior to considering a surgical procedure.

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