Carpal Tunnel Syndrome Exam - Clinical Skills - Dr Gill
Carpal tunnel syndrome is a relatively simple clinical condition yet is quite debilitating for Patients affected
Carpal tunnel, allows the median nerve to transition from the forearm into the hand. Unfortunately, if the carpal tunnel becomes inflamed, narrowed or irritated, the median nerve will become compressed.
In this clinical examination video, we look at the steps required to conduct an examination of possible compression of the median nerve to a level which would be required in a medical school OSCE assessment
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Please note that there is no ABSOLUTE way to perform a clinical examination. Different institutions and even clinicians will have differing degrees of variations - the aim is the effectively identify medically relevant signs.
However during OSCE assessments. Different medical schools, nursing colleges, and other health professional courses will have their own preferred approach to a clinical assessment - you should concentrate on THEIR marks schemes for your assessments.
The examination demonstrated here is derived from Macleod's Clinical Examination - a recognized standard textbook for clinical skills.
00:00 - Introduction 00:22 - Symptoms 00:45 - Examination Overview 01:05 - Visual Inspection of Hands 01:35 - Physical Examination of Hands 02:07 - Hand Movement and Strength Assessment 02:55 - Sensory Test with Neurofilament 03:42 - Tinel's Test 04:54 - Phalen's Test 06:00 - Direct Pressure Over Carpal Tunnel 07:20 - Conclusion and Next Steps
[Music]
foreign
I've been asked to have a chat with you
about your hands today before we start
please confirm your name and date of
birth it's harvest Harvey 2nd of January
2000. super so before we go on could you
tell me what's going on with your hands
so I've been experiencing sort of
tingling and sort of pins and needles in
my hand and I get pain quite Eliza okay
and now you're right or left-handed I'm
right-handed and just Effect one or both
hands both
so um as we've mentioned
um to me before I came in it does sound
like this could be carpal tunnel
syndrome so would you mind if we did an
assessment of your hands super so that's
going to involve having a look at your
hands getting you to do some movements
and then we're going to press around
your hands and see what the sensation's
like is that okay yeah super so I'm just
going to take this pillow and if you can
put your hands Palm up to start off with
please
so just having a look to see what we can
see
can't say any obvious issues so that's
good if you could turn your hands over
for me please
checking over the mcps and the Pips and
dips I can't see any evidence of
swelling that might associate with
rheumatoid arthritis I can't see any
changes to the skin if you could turn
backwards for me so I'm just going to
press over your hands if that's okay
just pressing over the muscles to see
how things feel there
over some of the bones
do the same again
I'm just feeling along my hands make
sure there's nothing else there
I'm just going to squeeze slightly
any problems when I do that
a little bit okay so we're now just
going to get you to do some movements if
that's okay so if you can put your
thumbs upwards for me and keep them in
this position okay don't let me move
them
okay so slightly weak on one side
compared to the other
and if you could take your thing a thumb
and put it to your ring finger please
okay now don't let me move your hands
through
okay
okay so you've got good strength with
that so if you could undo your button
and redo it for you please
and then close again
and have you noticed any problems
picking things up doing buttons Etc
um no not really okay thank you
so if you put your hands again flat so
I'm going to take this neurofilament and
I'm going to touch around your hands
when your eyes are closed and I want to
say yes if you can feel it okay so to
start off I'm just going to touch here
so can you feel that and can you feel
that
yeah super so if you close your eyes for
me and say yes if you feel me touch it
yeah
yeah
yes
yeah okay so your sensation is intact
that's good
um we're going to do some additional
tests now these might be uncomfortable
so I'm going to take the Tenon hammer
and I'm going to tap over the bases of
your hand and we're going to do that for
over about 30 seconds okay and we're
going to see if you get any of those
Sensations okay so please tell me to
stop if it becomes painful
any problems with that no so no pens and
needles there slightly okay whereabouts
are you getting those pins and needless
yeah just flowing up okay and did it
affect your little finger as well
no
I'm going to the same again on this hat
so again tell me to stop if it becomes
painful
any problems with that okay did you get
any pins and needles as you did with the
other hand okay so the next thing we're
going to do I'm going to get you to put
your hands up with your wrists down and
with your part the back of your hands
together okay so I now need to stay here
for at least 60 seconds if you get any
changes of sensation to your hands
please tell me okay
and did you notice any changes to your
sensation there okay so no pins and
needles any pain or numbness okay so if
you put your hands back on the side here
for me so now I'm going to press
directly over the carpal tunnel okay
okay this will be uncomfortable okay if
it becomes too painful please tell me to
stop I'm going to press down with quite
a bit of force I'm going to do that for
30 seconds
any changes when we did that let's open
the needles there
nothing anything to your little finger
no
okay we're gonna do the same again over
here so you can press down quite hard
okay any changes as we did that no okay
so from what certainly what we're seeing
on your right hand we do have features
that could be in keeping with carpal
tunnel so what we can look at doing with
regard to that um do you have any
problems taking anti-inflammatories no
so we can certainly start off with some
of those however they're probably not
going to have a huge impact on this
um the other thing we can look at is
because as you said it's slightly worse
at night giving you a night splint to
hold your wrist so that you're not
getting a stretch over the tissue there
but because of what you've said and
um the signs that we've found today we
will do a referral to the orthopedic
team who can look at doing operation to
release that carpal tunnel and hopefully
reduce the problems you're getting
do you have any other questions for me
about this no super well thank you very
much your time thank you
foreign
