Carpal Tunnel Syndrome: A Summary of Clinical Practice Guideline Recommendations

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Using the Evidence to Guide Physical Therapist PracticeBOTTOM LINE FOR PRACTICEExamination for CTS should include a thorough history and symptom assessment, the Katz hand diagram, static 2-point discrimination, monofilament testing, the Phalen test, the Tinel sign, the carpal compression test, and the wrist ratio index, as well as the CTQ-symptom severity scale and CTQ-functional scale or the Disabilities of the Arm, Shoulder and Hand questionnaire. Dexterity may be assessed using the Purdue Pegboard or the Dellon-modified Moberg Pickup Test. Baseline grip and 3-point or tip pinch strength may also be assessed.Individuals with severe CTS, as evidenced by thenar atrophy or electrodiagnostic findings, should be referred to a physician for surgical consultation. Individuals with CTS should be provided with a wrist orthosis, worn at night with the wrist situated comfortably at or near a neutral position. Clinicians should not use low-level laser therapy, iontophoresis, or magnet therapy.After consideration of associated costs and contraindications, additional nonsurgical interventions may be added. These include modification of the orthosis design and prescription, ergonomic interventions, superficial heat, interferential current, phonophoresis, manual therapy, and exercise (lumbrical or general stretching). Patients who regress or do not improve should be referred to a hand surgeon. A flow chart summarizing key elements of diagnosis and treatment of CTS is provided on the next page.

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