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Orthopedic manipulation of carpal tunnel syndrome, pure dry goods

Source of information: Time: 2020-02-21 02:42:26

Millennium Tongzhou vitality north stream

Carpal tunnel syndrome is the most common type of peripheral nerve entrapment syndrome. It is common in middle-aged people. It is a series of symptoms and signs caused by median nerve compression in the wrist.
What are the manifestations of carpal tunnel syndrome and how to diagnose it?
First, clinical manifestations The clinical manifestations of carpal tunnel syndrome are mainly the median nerve compression index finger, numbness of the middle finger and ring finger, tingling or burning-like pain, exacerbation at night after work, and even awake during sleep; local pain is often radiated to Elbows and shoulders; poor thumb abductor muscles, occasional end objects, sudden misses when lifting, check: compression or throbbing of the transverse ligament of the wrist, increased pain when the wrist is stretched back; elderly patients, may have big fish Muscle atrophy, wrist, palm surface, thumb, index finger, middle finger numbness, pain, or inflexible hand movements, weakness, etc .; pain symptoms worsen at night or early morning, can be radiated to the elbows, shoulders, daytime activities and hand shake Feeling weakened or disappeared in the above areas; even hand muscle atrophy and paralysis occur. If this happens and does not relieve for several days in a row, experts recommend that you go to a regular hospital as soon as possible to make an early diagnosis. Take measures.
Clinically, some patients will suffer atrophy of the "big fish" muscles under the thumb due to long-term lesions; even intermittent whitening and cyanosis of the skin; severe cases of thumb, forefinger cyanosis, fingertip necrosis, or atrophic ulcer And become an irreversible change.
Carpal tunnel syndrome is more common in people aged 30 to 50 years, and women are five times as likely as men. Bilateral disease accounts for about 1/3 to 1/2. Bilateral disease occurs for women: 9: 1 for males. Pressure, thumb, food, middle finger produce pain and numbness. The sensory dysfunction of the fingertips is often manifested in the initial stage. It often wakes up due to numbness or burning pain several hours after falling asleep. It is relieved after activity. A few patients appear due to a longer course of illness. Neurotrophic disorders, atrophy of the great intermuscular muscles, intermittent whitening and cyanosis, severe cases may show thumb, forefinger cyanosis, fingertip necrosis or atrophic ulcers, can be tapped on the center of the palm of the wrist during inspection, causing the median nerve Numbness and pain in the dominating area, which is positive for the Tinel sign. In some patients, the wrist joint is extremely flexed after 60 seconds, and the finger feels abnormal and worsens. This is positive for the Phalen test. Using a sphygmomanometer to pressurize the upper arm to the distal limb veins can cause symptoms appear.
Second, when the diagnosis of carpal tunnel syndrome is suspected, the following tests should be performed to confirm the diagnosis:
① Tinel's sign, with the finger at the proximal edge of the wrist ligament hit the median nerve site, thumb, food, middle three fingers with radiation pain were positive.
② Wrist flexion test, with the elbows resting on the table, the forearms perpendicular to the table, and the wrists flexed naturally. At this time, the median nerve was pressed on the proximal edge of the transverse ligament of the wrist. Carpal tunnel syndrome patients soon experienced pain.
③ Cortisone test, hydrocortisone injection in the carpal tunnel, if pain relief can help confirm the diagnosis.
④ Tourniquet test, inflate the sphygmomanometer to the systolic blood pressure for 30 to 60 seconds, which can induce finger pain is positive.
⑤ Wrist extension test, to maintain the wrist in the hyperextension position, and those who soon experience pain are positive.
⑥ Shiatsu test, it is positive that the finger compression can induce finger pain at the compression point of the median nerve in the proximal margin of the transverse transverse ligament of the wrist.
⑦ Median nerve conduction velocity. Normally, the median nerve conduction velocity from the transverse wrist to the thumb to the palm or short abductor muscle is less than 5 microseconds. If it is longer than 5 microseconds, it is abnormal. Carpal tunnel synthesis Signs can reach 20 microseconds, indicating that the median nerve is damaged. Those with a conduction time greater than 8 microseconds should consider surgery.
III. Orthopedic Manipulation 1. The patient lies on his back, and the operator stands beside the arm that stretches on the wrist side of the patient's dysfunction.
2. The operator's medial hand controls the patient's big thumb muscle (see Figure 1).
3. The operator holds the small fish muscle of the patient with his other hand and flips his palm upward to drive his forearm to spin back (see Figure 2).
4. After full posterior rotation, the operator flexes the patient's wrist to its tolerance limit (as shown by the long arrow in Figure 3), and pushes his thumb to the back (short arrow).
5. The operator continues to apply pressure, and slowly rotates his forearm forward to the comfort limit, and applies a force toward the ulnar disengagement point (see Figure 4).
6. The operator reassessed the abnormal tissue structure, asymmetry of the body position, many restrictions and tender points.

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