Pathophysiologyepidemiology Caused by compression of median nerve Can cause edema devascularization demyelination Myriad factors contribute to development Irritation of flexor tendons rheumatoid arthritis congenital deformity of retinaculum ID: 670043
Download Presentation The PPT/PDF document "Carpal Tunnel Syndrome Alaitia Enjady, ..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Carpal Tunnel Syndrome
Alaitia Enjady, Brett Hager, Hannah Chaney & Stephanie MutherSlide2
Pathophysiology/epidemiology
Caused by compression of median nerve
Can cause edema, devascularization, demyelination
Myriad factors contribute to developmentIrritation of flexor tendons, rheumatoid arthritis, congenital deformity of retinaculumRepetitive use injury controversialNot necessarily an inflammatory processMore prevalent in industrial settingSignificant contributor to workplace absence
http://www.uptodate.com.libproxy.nau.edu/contents/carpal-tunnel-syndrome-clinical-manifestations-and-diagnosis?source=search_result&search=carpal+tunnel+syndrome&selectedTitle=2~135
http://www.uptodate.com.libproxy.nau.edu/contents/carpal-tunnel-syndrome-etiology-and-epidemiology?source=search_result&search=carpal+tunnel+syndrome&selectedTitle=3~135Slide3
Presentation
http://www.uptodate.com.libproxy.nau.edu/contents/carpal-tunnel-syndrome-clinical-manifestations-and-diagnosis?source=search_result&search=carpal+tunnel+syndrome&selectedTitle=2~135
Classically pain and paresthesia in median nerve distribution
Often more severe at night
Relieved by shaking, wringing hands, running under water
Distribution of symptoms may vary
Wasting at Thenar Eminence
Weakness or clumsiness using hands
Often bilateral
Provoked by postural changes in the handSlide4
Differential Dx
Fairly easily diagnosed with clinical signs and symptoms
Number of provocative maneuvers use to diagnose
Tinels, Phalens, CT Compression, hands over headWhat else could it be?Nerve conduction studies and/or electromyography can be used to confirm diagnosishttp://www.uptodate.com.libproxy.nau.edu/contents/carpal-tunnel-syndrome-clinical-manifestations-and-diagnosis?source=search_result&search=carpal+tunnel+syndrome&selectedTitle=2~135Slide5
Patient
Claudia is a 42 year old woman who
works in a meat-packing plant.
After year 1- started to feel numbness and tingling in her right thumb, index, and middle fingerPt c/o pain and swelling in her R wrist and handPain- worse at night and keeps her awake Beginning to drop things due to numbness and weakness in her handhttp://www.moveforwardpt.com/symptomsconditionsdetail.aspx?cid=9f3cdf74-3f6f-40ca-b641-d559302a08fc#PatientExperienceSlide6
Initial Evaluation
Tests & Measures:
Tinel and Phalen tests performed on R side- (+)
AROM & PROM- WNLStrength (arm, wrist & hand MMTs)- slight weakness in R wrist & handTreatment: Patient education on upper-back & neck posture, wrist positioning for activities, & alternating hands at work.Slide7
Impairments
Weakness
Pain
SwellingFunctional Limitation: unable to safely & effectively complete work at meat-packing plant. Slide8
Treatment Plan
Modalities/Pain Control:
Ultrasound* - Deep, pulsed was found to be effective while continuous, superficial was found to be ineffective
1 MHz, 1.0 W/cm2, pulsed mode 1:4, 15 minutes per sessionE-Stim - Decrease swelling, inflammation and painTENS for pain controlNMES for neuro-reeducation after surgery?STM* - Break up scar tissue,focus on palmar fascia, promote tissue compliance
Ice - Pain control at end of session
The interventions listed here are often appropriate for Week 1
Muller, Effectiveness of hand therapy interventions Slide9
Treatment Plan Cont’d
Exercise - strengthening and stretching
Nerve gliding*
Dexterity exercisesFlexor retinaculum stretch* Lengthen abductor pollicis brevis and opponens pollicis Manual Therapy* - joint mobilizationCarpal bonesHatha Yoga*
Biweekly 60- to 90-minute hatha yoga sessions for eight weeks
Splinting/bracing* - for home and workplace
Education - Ergonomic and postural training
Sensory stimulation and discriminative sensory reeducation
Muller, Effectiveness of hand therapy interventions Slide10
Example exercisesSlide11Slide12Slide13
What about surgery???
Usually a release of the flexor retinaculum
Actually has pretty good outcomes
49% of people are cured28% of people were much better7% were worse You should know:
Precaution!
Avoid active wrist flexion past neutral as well as active finger flexion with wrist flexed during first 10 days post surgery
Use extreme caution for up to 3 weeks post-op to prevent bowstringing of flexor tendons
Kisner,
Therapeutic Exercise & Carpaltunnel.netSlide14
Home Exercise Program
Night-time splinting to keep wrist in neutral(wrist and MCP support)
Brininger T, et al.
Ergonomical work station (avoiding wrist flexion & wrist only movements)Anti-vibration glovesSlide15
Home exercise Program
Limited evidence to support exercise as an effective treatment
(
Piazzini D,et al)Tendon Gliding Nerve Gliding
Kisner Colby L.
Therapeutic Exercise
. Slide16
Take home points
Decrease any compression on the median nerve
Education
Lifestyle modifications ComplicationsSlide17
References
Brininger T, Rogers J, Holm M, Baker N, Li Z, Goitz R. Efficacy of a Fabricated Customized Splint and Tendon and Nerve Gliding Exercises for the Treatment of Carpal Tunnel Syndrome: A Randomized Controlled Trial.
Archives of Physical Medicine and Rehabilitation
. 2007;88(11):1429-1435. doi:10.1016/j.apmr.2007.07.019.Carpal Tunnel Syndrome. American Physical Therapy Association. 2012. Available at: http://www.moveforwardpt.com/symptomsconditionsdetail.aspx?cid=9f3cdf74-3f6f-40ca-b641-d559302a08fc#PatientExperience. Accessed July 18, 2016.Carpal Tunnel Syndrome | Forster Physical Therapy.
Forsterptcom. 2016. Available at: http://www.forsterpt.com/node/83. Accessed July 15, 2016.
carpaltunnel.net - carpaltunnel Resources and Information.
Carpaltunnelnet
. 2016. Available at: http://carpaltunnel.net/. Accessed July 18, 2016.
Ebenbichler G, Resch K, Nicolakis P et al. Ultrasound treatment for treating the carpal tunnel syndrome: randomised "sham" controlled trial.
BMJ
. 1998;316(7133):731-735. doi:10.1136/bmj.316.7133.731.
Kisner Colby L.
Therapeutic Exercise
. Philadelphia: F.A. Davis; 2007.
Kothari MJ.
. Carpal tunnel syndrome: Etiology and epidemiology. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA (Accessed on July 14, 2016.)Slide18
References cont’d
8. Kothari MJ.
. Carpal tunnel syndrome: Clinical manifestations and diagnosis. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA (Accessed on July 14, 2016.)
9.Muller M, Tsui D, Schnurr R, Biddulph-Deisroth L, Hard J, MacDermid J. Effectiveness of hand therapy interventions in primary management of carpal tunnel syndrome: a systematic review. Journal of Hand Therapy. 2004;17(2):210-228. doi:10.1197/j.jht.2004.02.009.10. Piazzini D, Aprile I, Ferrara P et al. A systematic review of conservative treatment of carpal tunnel syndrome. Clinical Rehabilitation. 2007;21(4):299-314. doi:10.1177/0269215507077294.Slide19