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Webnerves of The Hand
Webnerves of The Hand
• The Dorsal cutaneous branch supplies the medial half of the dorsum of the
hand and the 5th finger and medial half of the 4th digit. The superficial
branch supplies the anterior surface of the 4th &5th digits.
• The Deep branch supplies the hypothenar muscles, the interossei, the
lumbricals of the 4th & 5th digits and the adductor pollicis and deep head of
the FPB.
• This branch also supplies local joints.
• The ulnar nerve is “the nerve of fine movements”
Radial Nerve
• The superficial branch
of the radial nerve
pierces the fascia
near the dorsum of
the hand to supply the
skin over the lateral
2/3rds of the dorsum
of the hand, thumb
and proximal lateral
1&1/2 digits.
29
..
28.
30.
Carpal Tunnel Syndrome
• Paresthesias are the primary & initial complaint.
• Usually worse at night and relieved by hand movement
• Decreased grip strength and dropping things
• Thenar wasting is an indication of chronic compression.
• Relationship with repetitive motion activities has not
been proven but is suggested.
• Hypothyriodism, osterarthritis, diabetes, wrist trauma,
pregnancy, hypothyroidism, Acromegaly, Tumor (lipoma,
ganglion cyst (synovial cyst
Carpal Tunnel Syndrome
• Phalen's maneuver is performed by flexing the wrist gently as far as
possible, then holding this position and awaiting symptoms. A
positive test is one that results in numbness in the median nerve
distribution when holding the wrist in acute flexion position within 60
seconds. The quicker the numbness starts, the more advanced the
condition.
• Tinel's sign, a classic, though less specific test, is a way to detect
irritated nerves. Tinel's is performed by lightly tapping (percussing)
the area over the nerve to elicit a sensation of tingling or "pins and
needles" in the nerve distribution.
• The carpal compression test, or applying firm pressure of the palm
over the nerve to elicit symptoms has also been proposed
Fig B6.29 p 840
• YouTube - Carpal Tunnel Release,
DoctorMahoney.com
A systematic review of conservative treatment
of carpal tunnel syndrome.
Clin Rehabil 2007 Apr;21(4):299-314
Piazzini DB, Aprile I, Ferrara PE, Bertolini C, Tonali P, Maggi L, Rabini A, Piantelli S,
Padua L
Department of Physical Medicine and Rehabilitation, Catholic University, Rome,
Italy.
OBJECTIVE: To assess the effectiveness of conservative therapy
in carpal tunnel syndrome.