Carpal Tunnel Syndrome: Assessment and Treatment

Develop a practical approach to hand numbness, tingling, weakness, and functional loss that may represent carpal tunnel syndrome. Ten connected sessions address anatomical localization, clinical probability, competing conditions, neurological severity, conservative intervention selection, reassessment, and the therapist's role before and after surgical decompression. Original cases emphasize decisions that protect neurological function while supporting meaningful daily activity and work.

Learning Objectives

• Anatomy and Clinical Findings: Describe clinically relevant carpal-tunnel and median-nerve anatomy and relate that anatomy to common sensory, motor, and functional findings.
• CTS Presentations: Recognize typical and atypical CTS presentations, including nocturnal symptoms, paresthesia, dexterity changes, weakness, and advanced motor findings.
• Probability-Based Examination: Apply a probability-based examination approach using history, symptom distribution, CTS-6 concepts, provocative testing, sensory findings, and motor/function assessment rather than relying on one special test.
• Differential Screening: Differentiate findings consistent with CTS from cervical radiculopathy, proximal median neuropathy, ulnar neuropathy, polyneuropathy, and other competing presentations.
• Neurological Compromise and Escalation: Identify findings suggesting progressive or advanced neurological compromise and recognize when referral/escalation should take priority over continued conservative treatment.
• Conservative Interventions: Compare the evidence, limitations, and appropriate clinical roles of wrist orthoses, exposure modification, manual therapy, neural/tendon mobilization, exercise, strengthening, and other conservative interventions.
• Treatment Response and Reassessment: Use symptoms, function, sensory findings, motor status, occupational performance, and appropriate outcome measures to evaluate treatment response and reconsider management when improvement is inadequate.
• The Broader Care Pathway: Describe the therapist's role in the broader care pathway involving corticosteroid injection, surgical decompression, postoperative recovery, and return to activity/work.