Carpal Tunnel Syndrome: Clinical Practice Guidelines
Diagnosis
– Monofilament testing of middle finger and radial finger to determine extent of nerve involvement for sensory changes
– Use of Phalen test, Tinel test and Carpal Compression test
– Asses for: patient older than 45, whether shaking hands relieves symptoms, sensory loss in thumb
Examination
– Can use validated outcome measures to assess symptoms (CTQ-SSS), function (CTQ-FS, DASH)
– Compare grip or pinch strength to established norms
Interventions
– Ergonomic changes to desk set up can be recommended
– Neutral positioned wrist splint for night time use for short-term symptom relief
– Can progress to include part-time day use for mild to moderate symptoms
– Heat can provide short-term symptom relief
– Low-level laser or thermal ultrasound should NOT be used
– Physiotherapy should be performed including manual therapy and therapeutic exercise for mild to moderate symptoms
– Steroid injection can be considered for mild to moderate symptoms in conjunction with physiotherapy and splinting, but relapse is common
– Severe carpal tunnel syndrome, defined as thenar muscle wasting and constant numbness, should be offered physiotherapy
Exercise and mobilisation interventions for carpal tunnel syndrome (Cochrane Review): Page_et_al-2012-Cochrane_Database_of_Systematic_Reviews
Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Academy of Hand and Upper Extremity Physical Therapy and the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2019;49(5):CPG1-CPG85. doi:10.2519/jospt.2019.0301
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