Carpal Tunnel Syndrome Exam - Clinical Skills - Dr Gill

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
________
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.
#CarpalTunnel #ClinicalSkills #DrGill
You can now consult via video or in person with Dr Gill at Dr Finlay’s Private Practice - www.drfinlays.co.uk/services/...
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

[@maxazzopardi7446]

I love the ASMR community has helped launch Dr. James Gill's channel which is a genuinely excellent medical channel that teaches us so many things. Even average men and women like myself can gather a lot of really useful information from these videos.

[@lucasborba8500]

I tend to watch these videos for the sensation they provide, but I can't deny that I've also learned a great deal! Dr. James Gill draws in a wide range of audiences

[@jameshinze7878]

I really like when a patient has a real health problem and you diagnose it. Then discuss what to do to help or prevent it from getting worse.

[@DrJamesGill]

It is a simulation here, but sometimes - like the carpal tunnel exam demo - you need a little more than the request to do the exam

[@theendofmyropemydude]

I also like when I receive free health care on KZbin because there's none available IRL lmao

[@khalilkhamis8556]

​@@DrJamesGill😊😊

[@hopel4822]

When he said 2000 as a birth year, my gut reaction is still to go, "What, how? Absolutely not, you'd still be a child"`

[@sunnyside60]

And he's married as well, 2000 is further away than my brain can compute

[@WhisperAudiosASMR]

I hate how accurate and depressing this comment is 😂😂😭😭

[@adrianrowden8266]

​@@WhisperAudiosASMRIf he was born a couple of days earlier he would have had the chance to live in 3 centuries.

[@CarinaKi]

It’s mind blowing really.

[@Katiedora122]

Seriously. I was like, how is that infant talking??

[@antoinehunter3776]

I remember when abbie was in that chair

[@WannieStouters]

Not the same without Abbie Tutt haha

[@learicist]

I remember when that chair was in … I got nothing

[@Daytonian17]

Aiden Cross

[@igormac88]

She was a medicine miracle 😅

[@syedwaleedahmedshah8089]

How dare you sit where she used to 😭

[@tayzonday]

I once did an electrical carpel tunnel test where they taped wires on my arm to see which fingers the wires triggered.

[@DrJamesGill]

That’s the gold standard treatment - nerve conduction testing, but unfortunately it’s difficult to access.

[@tayzonday]

@@DrJamesGill Yeah I was in humanities grad school at the University of Minnesota - which has a big teaching hospital with every speciality in a major city. It’s hard to scale advanced care the further one gets from big cities.

[@kevedo93]

i love how i cross tayzonday every once in a while on youtube comment section

[@holnrew]

I had that done on my ulnar nerve, strange experience

[@firekind1980]

@@kevedo93 Hope he's well.

[@panayiotissavvas]

I really liked the fact that this was also a simulation of a possible problem in the hands. Thank you Dr. !

[@DrJamesGill]

We’ll be doing a few more of these where we are needing to look at specific examinations

[@danielhorton9929]

Your professionalism is something I try to mimic in my job. Great work 👍

[@DrJamesGill]

Thank you. I try to treat the patient as I would like to be treated

[@noellegunning3301]

Yes, Dr. Gill is top class.

[@theoneandonlyYouTuber]

@Dr James Gill, appreciate what you do for the community.😊

[@karlmitchell4879]

Glad to see you back Doctor Gill and what a video to return to!

[@chadsmith1200]

I really wish more people would watch your videos. They are missing out.

[@lamecasuelas2]

This Is great, this Is quickly becoming one of my favorite channels! Good work Dr.!

[@DrJamesGill]

Glad you enjoy it!

[@sortbum]

We need to have Dr Gill & Dr Hollie Berry join forces for an ASMR super-duo. That would be lovely.

[@greenidgoddess5]

Lovely and floppy 😂

[@Dakbryant]

Along with Andrew

[@lamecasuelas2]

Ooof!

[@mynamehereforsure]

Lovely and floppy putabitofpaper

[@thiagobelline]

@@Dakbryant They still say Andrew is still one of the final medical students 😂

[@YouTudey]

Great to have you back Dr. Gill! Happy to see you are doing well!

[@DrJamesGill]

Thank you kindly!

[@Denjalaz]

​@@DrJamesGillдень 😢 шаг уд🎉

[@fancyslayer99]

As someone who has severe carpel tunnel thanks to years of using hand/power tools, when he did the upside down prayer, I winced in pain. That position is excruciatingly painful for me.

[@LoraLinn]

Thank you very much ❤ it was a fantastic video, as always 👍!

[@DrJamesGill]

I hope it was useful. We’ll follow up with the deep dive looking at the why of carpal tunnel

[@personalinjuryshow]

Awesome work doctor, thanks for sharing your knowledge.

[@josephmalala1093]

My first video from him and I'm hooked 🙇🏾‍♂️🙇🏾‍♂️🙇🏾‍♂️quality asmr

[@Malkumecks]

As someone that just had surgery on both hands, I can assure you that this video was almost double the amount of time that I spent in the office with my hand surgeon.

[@DrJamesGill]

Unfortunately, sometimes it’s more obvious what is going on, so it can see like a shortened consultation. I was actually worried it was a “me” issue, but then did an athlete clinic, and the amount of abnormalities is “healthy” people when you REALLY put them under the microscope, I don’t think I’m going to worry I hope your op went well though?

[@Chad-bc9vi]

​@@DrJamesGill the fact that he hasn't replied to your comment yet make me quite worried lol 😂

[@Wafaloo]

@@Chad-bc9vihe’s still recovering from typing the first comment

[@akilghosh]

​@@Chad-bc9viactually he drank plenty of water and had a wonderful response

[@cyrus2295]

@@akilghosh within 24 hours after the operation, of course

[@tynka9647]

Funny to see that tbh! Im from Poland and my examination was a bit different. But now i am 2months post operation and my right wrist is doing better now! 😊😊😊 looking forward to see more of your videos with actually sick/disabled people! I am a rheumatic myself so it will be cool to see some deformed hands 😂😂😂

[@oceanceaser44]

Damn, I wish I could get a doctor like this in my country. I exploded my hand in a bike accident a year ago and haven't gotten even 1/10th of this kind of evaluation...

[@DrJamesGill]

Sorry to hear about the accident - How’s the hand now?

[@charlesmawson8393]

This is fantastic

[@starfishgurl1984]

Love this! I’m afraid at some point in the future I’ll end up with carpal tunnel in my left hand from over usage with bad posture because I can already feel the strain from time to time so it’s nice to know what to watch out for as warning signs should that happen, thanks!

[@rafaechizen]

This is so relaxing 😴

[@Dubstep4Jason]

Fun fact, i tested myself along the video and noticed some tingles in the hand. Went to a doctor turns out i have carpal. Imagine getting diagnosed via yt video 😂 thx doctor gill

[@jacktailorpatirzon6306]

exelente asmr,eres muy jenial para hacerlo

[@macdadstromboli2762]

Awesome! I have severe carpal tunnel in my left wrist. Yeah, it hurts and sucks!

[@DrJamesGill]

Hopefully you’ll be able to get treatment 😊

[@maddietaylor5751]

Are you a real doctor because I have carpoal tunnel syndrome and it makes me have seizures often so is there anyway I can see you in person I’m happy to fly out and meet you as you look like you actually care compared to my doctors

[@3DGvisuals]

I've been waiting for this one as I struggle with CTS. When I did the test shown at 5:45 my little fingers started to twitch involuntarily

[@DrJamesGill]

We’ve filmed the deep dive as well, so hopefully that will give you more insight too

[@rikkilumsden2655]

Yet another great video but I was wondering if at some point you could maybe cover sciatica and/or sleep apnea?

[@DrJamesGill]

Great suggestion! I’ll add it to the list

[@rikkilumsden2655]

@@DrJamesGill thank you so much 😀

[@wolfblood178]

when i try to do the elbow and wrist thing, i cant put my hand sfiemly together, and my elbows stick way out and a awkward position.

[@qloudz]

Where is Hollie Berry at?????

[@chadster69]

perfect, ive had a sneaking suspicion that i might have carpal tunnel syndrome for quite some time now

[@DrJamesGill]

Definitely worth while getting checked as it can cause long term issues

[@czarekp3552]

if i ever get cancer, i want dr Gill to give me the news.... - i'm afraid it's a cancer and it's terminal.... - great news, thank you doctor and how are you?

[@Svevladovich]

💀

[@ryanpaulson3334]

I would be interested to see what the process of testing tremors

[@EuanBCFC]

Dr Gill, why are all the comments turned off on the Warwick channel :(?

[@fatherchristmas8408]

How safe are operations to fix the carpal tunnels? I'm in my early 20s and are suffering from serious problems like numbness and lose of grip strength. But I've also heard of people where the operarions made it even worse. I would appreciate an answer. Thank you!

[@crazyfriend50]

Try exercises not surgery

[@umdoistrestestando5437]

I love hand examination kkkk i always relax with that :)

[@pauljones401]

Great to see a super loco!

[@L8-APEX]

Having a soothing voice is a prerequisite when conducting any kind of clinical exam. It's a rule.

[@barristanselmy2758]

Superb

[@solarus2120]

My journey so far in the wonderful world of carpal tunnel syndrome: Ring GP, describe symptoms. Referred for Nerve Conduction test Have Nerve Conduction test, reduced signal at wrist and elbow. Sent back to GP for steroid injection into wrist. Ring GP a week later as the swelling has now gone down and my symptoms are back/worse. Referred to musculoskeletal service. Pending appointment with musculoskeletal service. Paperwork was done incorrectly and once that was fixed, the phoneline had closed.

[@Berengier817]

Does gripping things help reduce it? IE those exercise equipment that is supposed to help strengthen writs and forearms that you have to squeeze your hands closed in

[@DrJamesGill]

I don’t believe so

[@isabelledavis2981]

I will have a physical exam this year on May 4th 2023 which is Star Wars day May the force be with you

[@facundogomez4513]

Greetins from Uruguay, the doc voice should be a british monument

[@heinrichvonwerdenfels7640]

Hello, here in Germany you have to wear rubber gloves in the exam or in the state exam, how about you? Since I see that Dr. Gil isn't wearing gloves. Best regards. With honor Dr. Von Werdenfels

[@DrJamesGill]

I do with most patients actually - a habit from my A&E rotation. Again, I think it might be habit at the medschool environment not too. By the same extension I tend to wear scrubs at work now post covid

[@andrewcullen2119]

Any good recommendations for dealing with tmj maloclussions at home? Like exercises? Etc?

[@DrJamesGill]

That would be something to discuss with your dentist

[@traceynickless681]

Hi would it be possible for you to look at adrenal insufficiency Addison's Disease which I've had for many many years I think it would be interesting for your students as it is still fairly rare Thankyou Dr Gill

[@DrJamesGill]

We should be able to get around to that when we do more endocrine stuff

[@danip2476]

I wish you could do more of these even tho I know you’re not an asmr channel

[@kohinarec6580]

I've had a sense of "pulling" in the tendon of my ring finger for a few weeks now. I wonder whether it is because of deadlifting, computer use or both.

[@ruthie_rosario]

It’s more likely from the computer. Usually, that feeling happens to people who type on the computer a lot for several years, or people who work in places like Tyson chicken, people who do heavy tire work (such as changing tractor tires), dental hygienists, massage therapists, or just about anybody who has demanding repetitive hand movements where the muscles in the hands are being worked for hours a day. My husband has this very problem. To bad when it comes from work, you can’t just stop 😢

[@kohinarec6580]

Thanks for your answer. It has since subsided after I trained less often w/ lighter loads at the gym and took to stretching my fingers at work. 🎉

[@Hickspy_]

Is there any reason why this would be triggered specifically in the mornings? Sometimes when I'm eating breakfast my hand goes pins and needles from the use of utensils, but it 1. Goes away if I drop my hand down, and 2. Doesn't really affect me the rest of the day.

[@DrJamesGill]

Maybe related to bring static over night, or sleeping position. Would be width while going to see your doctor to confirm

[@Fairychild432]

A sleeping position usually causes mine to tingle. I also have to straighten my arm out.

[@PaganiiLover]

You may not know the answer to my “problem” but I am unable to rotate my wrists to where my palms face up. If my palms are face down, the best I can do with my left hand is rotate it about 100° and my right hand can’t go beyond 90° making my right palm face left. I’ve had no surgeries on my shoulders/arms/wrists/hands that would affect it. I’ve asked two general doctors out of curiosity and they said they’ve never seen such a thing. Granted it’s not their expertise but it’s interesting

[@nettiplett]

I saw the doctor for suspected carpal tunnel syndrome just the other day and it was absolutely nothing at all like this. 🤷‍♀️ Nowhere near as thorough either. I was recommended to wear splints on both hands during the day and not at night. It's really hard to look after a baby with splints on my hands though, so can't say I've been wearing it much.

[@Cookivirus]

Medical practices and procedures differ between countries and places of study

[@cynthialovold9031]

Go see a good massage therapist and set up treatments. Carpal tunnel is correctable with massage therapy.

[@DrJamesGill]

Something I’m always very cautious with in medicine is. absolute statements - which I’d consider this to be - management of carpal tunnel issues depends on the cause, so RSI as an example *might* benefit from seeing a physio, but I’m not sure that at massage would have an effect (being clear that is very much a “I’m not sure” rather than disagreeing) The crux is you need to treat the cause of the carpal tunnel syndrome, so rheumatoid arthritis for example would NOT be affected by massage and could potentially be worsened.

[@cynthialovold9031]

@@DrJamesGill Thank you. Yes, I should not speak in absolutes. I believe if the root cause is lots of repetitive type motion that causes the fatigue and tightening, is where MT is helpful.

[@VintageYakyu]

If you're newly diagnosed with Carpal Tunnel and haven't yet had any testing done, such as a Nerve Conductivity Test, trust me you're going to love it.

[@lindar5413]

I had to have Carpal tunnel release surgery. Pain, was awful before.

[@DrJamesGill]

I hope it’s all resolved now?

[@nopenope5042]

Great asmr

[@sarux3]

I think it’s so funny that my school has its own version of dr. Gil. Just some random teacher who’s super nice got popular on KZbin

[@DrJamesGill]

That’s cool. What do the teach?

[@tbip2001]

This might be a silly question, but how often do you change the monofilament?

[@DrJamesGill]

Guideline say 6 months for a frequently used tip - eg in a diabetic clinic 12 month if less used - so my GP bag for example

[@tbip2001]

@@DrJamesGill thank you Dr, much appreciated

[@sarahhunter5261]

Wow you're in the UK

[@user-xv1dq6en7p]

may i ask if what special tests you used to asses?

[@DrJamesGill]

We did a follow up video specifying outlining what we are doing, and the subsequent special tests. I hope this is helpful How To Check for Carpal Tunnel Syndrome - Dr Gill kzbin.info/www/bejne/foXSeZt7hMelhpo

[@andreemanoel2366]

I was looking at my hands and I noticed a 'bump' in the back part of my left wrist, something that is not present in the right wrist. I'm considering going to a doctor to see what's going on.

[@DrJamesGill]

If you are thinking it, you probably should 😊

[@BobGymlan]

The biggest difference after quitting smoking was how warm and strong my fingers and toes felt. They were always so cold and clammy when I smoked.

[@DrJamesGill]

That’s interesting. Makes sense though with the better oxygenation

[@BobGymlan]

@@DrJamesGill I was basically asleep when I commented. Looking back, my comment has little to do with the vid… I just wanted to let you know that you’re one of the most holism, calming, and informative people on the internet. Thank you!

[@DrJamesGill]

Doesn’t matter if you were half asleep. It’s still a thing stopping smoking, congrats !! 😊

[@nickirwin5082]

What's the significance of sensations going to the little finger?

[@DrJamesGill]

Carpal tunnel issues should NOT affect the little finger

[@davidhocknull6520]

I have some issues with my wrists ligaments

[@tkingdoll]

Does that pillow have a washable cover?

[@DrJamesGill]

Ordinarily yes. However this was not filmed in a clinical environment and sometimes I have to make do with the props i can access To put it another way, in the NHS pillows are like gold dust - seriously - so I would not remove one from a clinical area where it may end up being needed

[@brandonjordan5772]

Is surgery the only treatment or can it be treated with physio?

[@DrJamesGill]

Surgery is very effective, but the best treatment depends on finding the cause

[@iWillRun_]

The contrast in their sitting posture is making me nervous

[@kapitanleutnant1]

My dad had one bad back in the late 1990s

[@Bytional]

Is the CTS genetic? sorry to ask but this seems run in every family members from my mom side.

[@DrJamesGill]

Shouldn’t be no. But that doesn’t mean that there isn’t a condition underlying which might have a family component. The question is always WHY has someone developed carpal tunnel syndrome

[@Bytional]

@@DrJamesGill Thank you doctor, this is something I never thought of, nor did my mom or grandmom's doctors.

[@dshadow01]

2:24 got scared for a second there.

[@robertmcdannold3757]

I’d undo my button for Dr Gill…

[@amyhundley9817]

What about recommending massage therapy??

[@DrJamesGill]

I don’t have that information, but I suspect it would not be effective. Similar to trying to stretch the ITB, the flexor retinaculum is going to be too thick and fibrous. Hence why the operation is to cut it

[@MeAg4in]

i get Carpal Tunnel like twice a year or so not too much

[@KindPigeonProductions]

Any advice for someone who’s had the surgery on both hands but the carpal tunnel has come back?

[@DrJamesGill]

You need to go to see your doctor for that to be looked at

[@KindPigeonProductions]

I sure was hoping for a miracle answer, doc. 🙂 love and appreciate all your videos.

[@nelsoncraigjr]

Dr. Gill, I do have a question. To preface, I am not a medical professional nor in the medical field at all. My question is this. If you are performing an exam and the patient says no to you performing a certain action (i.e. pressing over the hands) what would you do then?

[@DrJamesGill]

Investigate why they said no. As they have come to clinic suggesting they do want help To be honest, it’s never happened

[@roryengland1996]

Dr Gill, are you the same Dr James who took part in ‘Bear Grylls: The Island”?

[@DrJamesGill]

Yes we did a lecture at the uni about it after kzbin.info/www/bejne/bHLMeZV8Zcuhb68

[@bennaustin6632]

Over here plastics seem to do more carpal tunnel releases than orthos.

[@kragos6580]

Is the tingling in the hands not normal?

[@DrJamesGill]

Not normal. No

[@MrMit50101]

My hands feel numb and like they want to stay in a closed position and they a little weak

[@DrJamesGill]

I would suggest you se your GP

[@jeffz870]

unstoppable gillster at large

[@krystle8090]

how can someone get carpal tunnel and how can we decrease the risk of it?

[@DrJamesGill]

One of the commonest causes is repetitive strain injuries. Generally trying to ensure your desk / computer work doesn’t put strain on the carpal tunnel. But there are medical conditions was well that increase the likelihood

[@krystle8090]

@@DrJamesGill thank you :)!

[@kiayawilliams5714]

I wish dr gill could do my exam, I’m sure I’m showing signs of carpal tunnel.

[@DrJamesGill]

I’d politely suggest going to see your GP

[@Scripps-on2nx]

I really thought Dr. Gill was patrick jane for a second

[@1984simongraham]

See you made it safely back from bear grylls Island 😂

[@DrJamesGill]

That was a long time ago now! 🙀

[@jedrewmtal123]

I dont learn anything jajaja but this video is very VERY relaxing

[@mattkevlarlarock5469]

As a person who spends a lot of time on the computer I was wondering... how's the 40K going?

[@DrJamesGill]

I don’t really have time for something that size, so tend to do Necromunda

[@Notpoop906]

I can't do that thing at 5:35 without having my elbows a lot higher so it's more like a V shape than a flat line like he's making with his arms. Is he just particularly flexible at the wrists or am I not flexible at the wrists? 😂

[@jeffz870]

The gillster gettin handsy

[@Mikerille]

I’m actually curious, for these videos do you find people with the actual problems? Or just grab someone and be like “pretend and it’ll be super helpful” 🤔

[@blue_jay31]

I would fall asleep if he was my Doctor!

[@Flippirino]

2:23 "-and if you could take your thing.. ahem, thumb" I get mind blanks too Gill.. I do too Edit here is I forgot the r on "your"

[@jsowder19]

Edited in hitting the right hand when he was hitting the left hand lol.

[@olivertate4983]

Is the range of motion of his wrists around 5:20 unusual? I can't bend mine anywhere near that much 😂

[@DrJamesGill]

That is entirely normal

[@salehoubahssis2376]

ممتاز

[@LaMeowlla]

You're Balenciaga Ron Weasley

[@jordanwoolley3475]

My hands are a mess 😮 been butchering for 8 years hands hurt alot

[@toypaj]

00:45 Syndrone

[@DDSMASH74]

Rum: aah-ahhh! [strokes his hand] You have a woman’s hand, milord! I’ll wager these dainty pinkies never weighed anchor in a storm.

[@aaron1468]

“A night splint” 💅

[@matthewfurlani8647]

He said 2000..... 😭 Im getting old

[@hatnemtom]

Bro is so flustered to be at the company of the best doctor.