/
Carpal Tunnel Syndrome  Alaitia Enjady, Brett Hager, Hannah Chaney & Stephanie Muther Carpal Tunnel Syndrome  Alaitia Enjady, Brett Hager, Hannah Chaney & Stephanie Muther

Carpal Tunnel Syndrome Alaitia Enjady, Brett Hager, Hannah Chaney & Stephanie Muther - PowerPoint Presentation

luanne-stotts
luanne-stotts . @luanne-stotts
Follow
369 views
Uploaded On 2018-09-18

Carpal Tunnel Syndrome Alaitia Enjady, Brett Hager, Hannah Chaney & Stephanie Muther - PPT Presentation

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

carpal amp syndrome tunnel amp carpal tunnel syndrome wrist search uptodate nerve www 2016 therapy exercise clinical hand http

Share:

Link:

Embed:

Download Presentation from below link

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.


Presentation Transcript

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 exercisesSlide11
Slide12
Slide13

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