Carpal tunnel syndrome is caused by compression of the median nerve in the carpal tunnel. Symptoms include numbness and tingling in the hand that worsens at night. Diagnosis involves tests like Durkan's test and Phalen's test. Treatment begins conservatively with splinting, NSAIDs, and steroid injections. Surgery is considered if symptoms do not improve. De Quervain's tenosynovitis involves inflammation of tendons in the wrist and causes pain and tenderness over the thumb side. Diagnosis is via the Finkelstein test. Treatment includes splinting, injections, and possible surgery. Trigger finger causes catching or locking of the fingers and is due to tendon sheath

3.  Carpal tunnel syndrome is the most
common entrapment neuropathy
 mechanism is not completely
understood but can be considered
compression of the median
nerve traveling through the carpal
tunnel.
 Causes (ICRAMPS)
• Idiopathic
• Colles', Cushing's
• Rheumatoid
• Acromegaly, amyloid
• Myxoedeoma, mass, (diabetes) mellitus
• Pregnancy
• Sarcoidosis, SLE

4.  Numbness, pain or tingling sensation
 Increasing at night
 Clumsiness
 Loss of grip strength

5.  Durkan's test
 is the most sensitive test to diagnose carpal
tunnels syndrome
 performed by pressing thumbs over the
carpal tunnel and holding pressure for 30
seconds.
 Phalen test
 wrist flexed with elbow extended for ~60 sec
produces symptoms
 less sensitive than Durkin compression test
 Tinel's test
 provocative tests performed by tapping the
median nerve over the volar carpal tunnel

6.  Conservative:
› NSAIDS, night splints, activity modifications
 first line of treatment
• modalities
• night splints (good for patients with nocturnal symptoms only)
• activity modification (avoid aggravating activity)

7. • Steroid injections
• second line of treatment
• outcomes
• 80% have transient improvement of symptoms (of these 22% remain
symptoms free at one year)
• failure to improve after injection is poor prognostic factor
• surgery is less effective in these patients

8. • Carpal Tunnel Release
• indications
• failure of nonoperative
treatment (including steroid
injections)
• temporary improvement with steroid
injections is a good prognostic
factor that the patient will have a
good result with surgery)
• outcomes
• pinch strength return in 6 week
• grip strength is expected to return
to 100% preoperative levels by 12
weeks postop

10.  A stenosing tenosynovial inflammation of the 1st dorsal
compartment which includes
› abductor pollicis longus (APL)
› extensor pollicis brevis (EBP)
 Epidemiology
› common in
 woman 30-50 years
 racquet sports
 Pathophysiology
› causes include
 idiopathic
 overuse
 golfers and racquet sports
 post-traumatic
 postpartum

11.  radial sided wrist pain
 pain, tenderness, and
swelling over the thumb
side of the wrist
 difficulty gripping

12. › Finkelstein provocative maneuver
 ulnar deviated wrist with thumb clenched in fist
 tenderness over 1st dorsal compartment at level of
radial styloid

13. • Nonoperative
• rest, NSAIDS, thumb spica splint, steroid injection
• Steroid Injection technique
• steroid injections into first dorsal compartment

14. • Surgical release of 1st dorsal compartment
• indications
• severe symptoms and nonoperative management has failed

16.  Stenosing tenosynovitis caused by inflammation of the flexor tendon
sheath
 more common in diabetics
 ring finger most commonly involved
 Associated conditions
› diabetes mellitus
› rheumatoid arthritis
› amyloidosis

17.  caused by entrapment of the flexor tendons
at the level of the A1 pulley

18.  finger clicking
 pain at distal palm
near A1 pulley
 finger becoming
"locked in flexed
position

19. • Nonoperative
• night splinting, activity modification, NSAIDS

20. • steroid injections
• indications
• best initial treatment for fingers,
not for thumb
• technique
 combination of 0.5 ml of
dexamethasone (4 mg/ml) & 0.5 ml
of 1% plain lidocaine
 diabetics do not respond as well as
non-diabetics

21. • Operative
• surgical debridement and release of the A-1 pulley
• indications
• in cases that fail nonoperative treatment

23.  The plantar fascia is the thick connective tissue which supports the
arch on the bottom of the foot
 It runs from the tuberosity of the calcaneus forward to the heads of
the metatarsal bones
•The plantar fascia contributes to support
of arch of the foot
•The plantar fascia also has an important
role in dynamic function during gait

24.  Plantar fasciitis is a painful foot condition caused by inflammation of insertion
of the plantar fascia on the medial process of the calcaneal tuberosity.
 This associated with
› Pain
› Swelling
› Warmth of the affected area
› Redness of the adjacent skin
RISK FACTORS
•Obesity or sudden weight gain
•Long-distance running
•Tight Achilles tendon
•Shoes with poor arch support or soft soles

26.  Eletrotherapy
Ultrasound therapy
Phonophoresis
Iontophoresis
Contrast bath

27.  Stretching
 Calf muscle stretch
Calf muscle stretching can be either 3 times or 2 times day,
sustained(3mini) or intermittent(20sec).
 Plantar fascia specific stretch
Performed in sitting, with the patient placing the fingers of one hand
across the toes of the involved foot. Then pulling the toes back.

28.  Orthotic Device
› Heel cuffs
› Viscous elastic heel pad
› Accommodative inlays
› Prefabricated and custom made orthosis: All these orthosis used for exceesive foot
pronation and improvement of the condition.

29.  Steroid Injection