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Case
Study: Carpal Tunnel Syndrome
Dr. Gold is a 45-year
dentist who sustained injuries to the right hand and cervical spine in
a motor vehicle accident. After EMG testing, he was diagnosed with right
carpal tunnel syndrome (CTS) and right cervical (C7) radiculopathy. Dr.
Gold can no longer use his dominant right hand with the same skill, dexterity,
and strength that he did prior to his accident.
Activities of Daily Living
Dr. Gold is independent
in his personal care activities, but has difficulties using the right
hand to perform tasks that require fine manipulation and strength, e.g.
buttoning, shaving, squeezing toothpaste, turning keys and doorknobs,
opening jars or bottles holding the telephone; handling small coins, separating
and counting money; or more than brief writing. Dr. Gold cannot apply
force to use hand tools for basic home repairs and relies on his left
hand for driving.
Recreation/Leisure
Dr. Gold can no
longer play basketball, tennis, or racquetball. He finds that he now depends
on his left hand to lift and carry his 2-year old son.
Occupational Performance Issues
Because of issues
related mainly to the right hand, Dr. Gold can no longer perform lengthy
dental procedures and treatments and now relies on his associates to do
the more in depth treatments such as crowns and root canals. When using
routine dental tools, Dr. Gold has difficulty with fine coordinated tool
movements, depressing the syringe to give Novocain, finds himself periodically
dropping tools and often needs to stop and shake out his hand out hand
in the middle of a procedure. Overall, he has cut his hours and reduced
his income by about one third.
Evaluation
Findings
• Wrist and
hand mobility: within functional limits
• Thenar atrophy: mild
• Significant limitations in right hand strength
• Grip strength right 43 pounds, 81
pounds left
• Dominant hand weakness of about 50%
relative to the non-dominant hand
• Whole hand grasp reduced 60% compared
to norms for men his age
• Reductions in functional pinch strength
patterns of 50-60%
•Impaired sensation of the median nerve innervated digits (thumb,
index and middle)
•Decreased right fingertip control relative to the left for fine
and medium manipulation
•
Slower right
hand performance times
• Inability
to use tools with the right hand for sustained periods
• Writing
tolerance of < 5 minutes, with the need to shake out hand to relieve
paresthesias
• During
simulated dental work, Dr. Gold lacked smooth and isolated control of
basic dental tools, used multiple digits to support tools and help compensate
for altered sensation, was sensitive to vibration when using small drills,
and could maintain required work positions only briefly without symptom
exacerbation.
Summary
Two years post motor vehicle accident and injury, Dr. Gold has continued
symptoms related to persistent post-traumatic CTS that affect him at home
and work. His cervical symptoms are mostly resolved. Dr. Gold has not
undergone the carpal tunnel release recommended to relieve pressure on
the median nerve, despite persistent CTS symptoms of significantly reduced
strength and sensibility in his dominant hand that limit his abilities
to perform manipulative and strength tasks. He cannot use dental tools
more than briefly without symptom exacerbation. His lack of strength and
sensibility are felt to preclude safe and controlled usage of dental tools
and the performance of his full occupational duties as a Dentist in a
small practice.
Contact us at
973. 334.7499 or at ellen@ellenradersmith.com
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