Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome CPG Quiz

Thank you to all of the Authors who published and helped create this CPG and quiz.

REVIEWERS: Roy Altman, MD • Paul Beattie, PT, PhD • Eugene Boeglin, DPT • John Dewitt, DPT • Lauren Detullio, OT Amanda Ferland, DPT • Christopher Hughes, PT, PhD • Sandra Kaplan, PT, PhD • David Killoran, PhD • Murray E. Maitland, PT, PhD • Saurabh Mehta, PT, MS, PhD • Leslie Torburn, DPT • Emmanuel Yung, PT, DPT

Journal of Orthopaedic & Sports Physical Therapy

Volume 49, Issue 530, April 30, 2019, Pages CPG1–CPG85

https://www.jospt.org/doi/pdf/10.2519/jospt.2019.0301

Question Title

* 1. After the clinical evaluation of your patient, you decide that the results are consistent with a diagnosis of moderate carpal tunnel syndrome. Which of the following conservative interventions has the highest available evidence?

Applying an orthosis or support that positions the wrist in neutral in both the sagittal and coronal planes.

Switching to an ergonomic mouse

Teaching a home program of nerve gliding exercises

Teaching a home program of differential tendon gliding exercises

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* 2. Which of the following conservative biophysical interventions for carpal tunnel syndrome has the strongest published evidence?

lontophoresis

Magnet Therapy

Phonophoresis

Low Level Laser Therapy

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* 3. According the published CPG, when performing clinical evaluation of a person with suspected mild CTS, which of the following sensory tests are recommended? Choose all that apply.

Vibrotactile (tuning fork) testing

Static 2-point discrimination in the long fingertip

Moving 2-point discrimination in the thumb tip

Semmes-Weinstein minofilament 3.22 on the fingertips

Static 2-point discrimination in the thumb tip

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* 4. In the clinical setting, a positive Phalen test alone is diagnostic for the presence of CTS.

True

False

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* 5. The best dexterity test to demonstrate clinical change following carpal tunnel surgery is?

The Dellon-modified Moberg pick-up test

The Purdue Pegboard Test

Nine-hole peg test

Jebson-Taylor hand function test

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* 6. Not one of the diagnostic tests on its own has acceptable sensitivity, but evidence exists that combining the following test (measures) may lead to acceptable sensitivity and specificity?

Pinch strength, Katz diagram

Tinel sign and Phalen’s test

Semmes Weinstein and 2-point discrimination

Reversed Phalen’s test and original Phalen’s test

Question Title

* 7. You want to provide your patient who has moderate CTS with an orthosis to use during sleep. Based on available evidence, in which position will you place the wrist, and for what reason?

Place the wrist at 30 degrees of extension because this is the position of least pressure in the carpal canal

Place the wrist at 20 degrees of extension, because that is the functional position of the wrist

Place the wrist at 30 degrees of flexion to unload the median nerve in the carpal canal

Place the wrist between 10 degrees of flexion to 10 degrees of extension

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* 8. Your patient is a 79-year-old gentleman, who seeks your help to resolve difficulty to perform his woodworking hobby due to persistent numbness and weakness of the thumb. He approaches you directly as a first healthcare professional. You observe atrophy of the abductor pollicis brevis. Your recommendation is?

Refer to a hand surgeon for further diagnosis and possible treatment

Refer to a hand surgeon and treat with safety and ergonomic instructions for his woodworking instruction

Treat with a nighttime orthosis and ergonomic interventions

You explain the patient why you cannot help him solve his hand problems

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50% of survey complete.