A timed Phalen’s test predicts abnormal electrophysiology in carpal tunnel syndrome

This chapter presents general treatment strategies for carpal tunnel syndrome using a clinical case example. It discusses assessment and planning, diagnostic pearls, decision-making, surgical procedures (open and endoscopic carpal tunnel release), management pearls, aftercare, complications and their management, and evidence and outcomes. Physical exams, such as Phalen’s test or a Tinel sign over the median nerve, are introduced, whereas steps in the surgical procedure are shown with intraoperative photographs. The chapter provides information on modern practices for comprehensive management of carpal tunnel syndrome from start to finish.

Download Full-text

TINEL'S SIGN AND PHALEN'S TEST IN CARPAL TUNNEL SYNDROME

Orthopedics ◽

10.3928/0147-7447-19921101-08 ◽

1992 ◽

Vol 15 (11) ◽

pp. 1297-1302 ◽

Cited By ~ 73

Author(s):

Stuart H Kuschner ◽

Edward Ebramzadeh ◽

Darren Johnson ◽

William W Brien ◽

Randy Sherman

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Tunnel Syndrome ◽

Phalen's Test

Download Full-text

Modified Phalen's test as an aid in diagnosing carpal tunnel syndrome

Arthritis Care & Research ◽

10.1002/acr.20664 ◽

2012 ◽

Vol 64 (2) ◽

pp. 287-289 ◽

Cited By ~ 5

Author(s):

Sayeeda Bilkis ◽

Donald M. Loveman ◽

James A. Eldridge ◽

Shabnam Asgher Ali ◽

Abdul Kadir ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Tunnel Syndrome ◽

Phalen's Test

Download Full-text

HYPERVENTILATION PROVOKES SYMPTOMS OF CARPAL TUNNEL SYNDROME

Hand Surgery ◽

10.1142/s021881041250027x ◽

2012 ◽

Vol 17 (03) ◽

pp. 337-339

Author(s):

U. Aslam ◽

S. Afzal ◽

Shakir Syed

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Hospital Staff ◽

Respiratory Alkalosis ◽

Control Group ◽

Day Case ◽

Clinical Value ◽

Tunnel Syndrome ◽

Phalen's Test ◽

New Discovery

Hyperventilation causes respiratory alkalosis. The nervous system is more excitable in alkalosis. This phenomenon can be observed as paraesthesia in fingers and toes as well as around the lips in anxious patients breathing rapidly. We wanted to test this phenomenon on already irritable nerves like the median nerve in carpal tunnel syndrome (CTS). We deployed 50 patients who came in to the day case unit for carpal tunnel decompression with electro-physiologically proven diagnosis. We devised a test whereby patients were made to hyperventilate under prescribed conditions and repeated Phalen's test and Tinel's sign for comparison. These were compared with a control group chosen randomly among hospital staff. 86% patients had a positive result which was just behind Phalen's test in sensitivity. It was also 100% specific as there were no false positives. Hyperventilation is a phenomenon which provokes carpal tunnel syndrome. Its clinical value remains to be seen due to cumbersome method and probable patient non-compliance but it is a new discovery. It may be useful in other irritable-nerve-syndromes as a test to add to our available armament. It may be an additional factor or a primary reason for nocturnal paraesthesias in CTS patients.

Download Full-text

Work-related risk factors for Carpal Tunnel Syndrome among Majmaah University female touchscreen users

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.5.683 ◽

2019 ◽

Vol 35 (5) ◽

Author(s):

Walaa Sayed Mohammad

Keyword(s):

Risk Factors ◽

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Wrist Flexion ◽

Creative Commons ◽

Work Related ◽

Related Risk ◽

Computer Based ◽

Tunnel Syndrome ◽

Phalen's Test

Objectives: This study aimed to explore the prevalence of carpal tunnel syndrome symptoms among female touchscreen users at Majmaah University, Saudi Arabia and to make a comparison for the wrist range of motion between probable CTS and non-CTS female touchscreen users. Methods: Two hundred and twenty-two female touchscreen users were enrolled in the present study. Among this cohort, fifty-two were academic members, 40 were employees and 130 were undergraduates. A Digital Inclinometer device was used to assess ROM of the wrist movements. A computer-based questionnaire, Phalen’s test, and Tinel’s sign were used to investigate the presence of CTS symptoms. The study was conducted between November 2018 and February 2019 at Majmaah University. Results: The prevalence of probable CTS was 34.2% among touchscreen users; the percent of probable CTS was significantly higher in undergraduates compared to other touchscreen users. There was a significant reduction in wrist flexion between the tested groups. Conclusion: Female touchscreen users at Majmaah University tended to have a high-risk for CTS. Wrist ROM measurements, particularly wrist flexion, could be a beneficial indicator for anticipating deviations in wrist posture after long-term touchscreen use. It is necessary to consider the job nature, age, BMI, and duration of using touchscreen as risk factors for CTS symptoms. doi: https://doi.org/10.12669/pjms.35.5.683 How to cite this:Mohammad WS. Work-related risk factors for Carpal Tunnel Syndrome among Majmaah University female touchscreen users. Pak J Med Sci. 2019;35(5):---------. doi: https://doi.org/10.12669/pjms.35.5.683 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Download Full-text

Carpal tunnel syndrome

Translational Neuroscience ◽

10.2478/v10134-010-0001-3 ◽

2010 ◽

Vol 1 (1) ◽

Author(s):

Denis Čerimagić ◽

Ervina Bilić

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Flexor Muscle ◽

Flexor Retinaculum ◽

Tunnel Syndrome ◽

Phalen's Test ◽

Palmar Flexion ◽

Focal Neuropathy ◽

Dorsal Flexion ◽

Ct Volume

AbstractCarpal tunnel syndrome (CTS) is a compressive focal neuropathy of the median nerve (NM) at the wrist. We hypothesize that reverse Phalen’s test rather than the previously commonly proposed classic Phalen’s maneuver was a logical maneuver in the diagnosis of CTS from the anatomic, pathophysiological and electrophysiological viewpoint. Dorsal flexion of the hand results in an increase in the flexor retinaculum tension (RFT), extension of the finger long flexor muscle tendons and consequential NM entrapment between the tendons and flexor retinaculum (RF). Thus, the carpal tunnel (CT) volume is reduced, the intra-tunnel pressure is increased, while the RF to NM distance is decreased. On Phalen’s maneuver, the forced palmar hand flexion entails opposite consequences i.e. reduced RFT, relaxation of the finger long flexor muscle tendons, decreased pressure upon NM, slight increase in the CT volume, decreased intra-tunnel pressure and increased RF to NM distance. The hypothesis can be tested by a conductive NM study, preferably at three positions: mid-position (palmar/volar angle 180 degrees); forced dorsal flexion (palmar/volar angle about 270 degrees); and forced palmar (volar) flexion (palmar/volar angle about 90 degrees). Relative to mid-position, “deterioration” of electroneurography (ENG) finding is observed in dorsal flexion, whereas “improvement” of ENG finding is recorded in palmar flexion.

Download Full-text

Phalen’s Test in the Diagnosis of Carpal Tunnel Syndrome

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681_88_90160-x ◽

1988 ◽

Vol 13 (4) ◽

pp. 383-385

Author(s):

P. SEROR

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Significant Relationship ◽

Nerve Conduction ◽

Nerve Conduction Studies ◽

Wrist Flexion ◽

Control Subjects ◽

Tunnel Syndrome ◽

Phalen's Test ◽

Flexion Test

The wrist flexion test of Phalen has been studied in 127 patients with carpal tunnel syndrome and 20 control subjects, all of whom also had nerve conduction studies. There was a statistically significant relationship between the severity of electrical changes and the probability of a positive Phalen’s test. However 34% of patients had a negative test and 20% of control subjects a positive one.

Download Full-text

The Reliability of Physical Examination for Carpal Tunnel Syndrome

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(98)80132-0 ◽

1998 ◽

Vol 23 (4) ◽

pp. 499-502 ◽

Cited By ~ 34

Author(s):

R. G. MARX ◽

P. L. HUDAK ◽

C. BOMBARDIER ◽

B. GRAHAM ◽

C. GOLDSMITH ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Health Care Professionals ◽

Health Workers ◽

Interobserver Reliability ◽

Outpatient Setting ◽

Intraobserver Reliability ◽

Abductor Pollicis Brevis ◽

Tunnel Syndrome ◽

Phalen's Test

The goal of this study was to determine the interobserver and intraobserver reliability of static and moving two-point discrimination, Semmes-Weinstein monofilament testing, Tinel’s test, manual motor testing of abductor pollicis brevis, vibration and Phalen’s test in the diagnosis of carpal tunnel syndrome. Twelve patients with suspected carpal tunnel syndrome were examined in an outpatient setting. The interobserver reliability was satisfactory for all tests except for Semmes-Weinstein monofilament testing. Intraobserver reliability was also satisfactory for all tests. Static two point discrimination had higher reliability than moving two-point discrimination. Seven tests for the diagnosis of carpal tunnel syndrome were reliable in the hands of skilled health care professionals. Hand surgeons and hand therapists examined patients more reliably than occupational health workers.

Download Full-text

Carpal Tunnel Syndrome (CTS)

Saintika Medika ◽

10.22219/sm.v7i1.1090 ◽

2012 ◽

Vol 7 (1) ◽

Author(s):

Mochamad Bahrudin

Keyword(s):

Carpal Tunnel Syndrome ◽

Motor Unit ◽

National Health ◽

Carpal Tunnel ◽

Interview Study ◽

Nervus Medianus ◽

Health Interview ◽

Tunnel Syndrome ◽

Phalen's Test ◽

Long Acting

Carpal tunnel syndrome (CTS) adalah salah satu gangguan pada tangan karena terjadi penyempitan pada terowongan karpal, baik akibat edema fasia pada terowongan tersebut maupun akibat kelainan pada tulang-tulang kecil tangan sehingga terjadi penekanan terhadap nervus medianus dipergelangan tangan. National Health Interview Study (NIHS) memperkirakan bahwa prevalensi CTS yang dilaporkan sendiri diantara populasi dewasa adalah sebesar 1.55% (2,6 juta). Kejadian CTS pada populasi diperikrakan3% pada wanita dan 2% pada laki-laki dengan prevalensi tertinggi pada wanita tua usia > 55 tahun, biasanya antara 40 – 60 tahun. Penyebab CTS diduga oleh karena trauma, infeksi, gangguan endokrin, dan lain-lain, tetapi sebagian tidak diketahui penyebabnya. Penggunaan tangan yang berlebihan dan repetitif diduga berhubungan dengan sindroma ini. CTS bisa mengenai usia pertengahan, wanita lebih sering dari pada pria, biasanya pada tangan yang dominan dan prevalensi meningkat pada kehamilan. Pada tahap awal hanya gangguan sensorik, berupa parestesia, kurang merasa (numbness) atau rasa seperti terkena aliran listrik (tingling) pada jari dan setengah sisi radial jari, walaupun kadang-kadang dirasakan mengenai seluruh jari-jari. Bila penyakit berlanjut rasa nyeri dapat bertambah berat dengan frekuensi serangan yang semakin sering bahkan dapat menetap. Kadang-kadang nyeri dapat terasa sampai kelengan atas dan leher, sedangkan parestesia umumnya terbatas di daerah distal pergelangan tangan. Keluhan dirasakan terutama malam hari. Dapat pula dijumpai pembengkakan dan kekakuan pada jari-jari tangan dan pergalangan tangan terutama di pagi hari. Lebih lanjut lagi penderita mengeluh jari-jarinya menjadi kurang terampil misalnya saat memungut benda-benda kecil. Pada pemeriksaan fisik didapatkan Phalen’s test dan Tinel’s sign yang positif dan pada Pemeriksaan EMG dapat menunjukkan adanya fibrilasi, polifasik, gelombang positif dan berkurangnya jumlah motor unit pada otot-otot thenar. Penanganan faktor resiko akan memperbaiki gejala, penggunaan obat anti inflamasi untuk artritis tangan, mengurangi penggunaaan tangan yang berulang, mengistirahatkan pergelangan tangan, Pemasangan bidai pada posisi netral pada pergelangan tangan akan memperbaiki gejala. Pemberian obat anti inflamasi non steroid dan injeksi steroid dengan lidocain dan long acting steroid pada terowongan karpal akan mengurangi keluhan. Bila terapi konservatif gagal dilakukan tidakan operasi sebagi pilihan terakhir.

Download Full-text