28/07/2023
🌐Carpal tunnel syndrome (CTS) is an entrapment neuropathy caused by compression of the median nerve as it travels through the wrist's carpal tunnel. Normal tissue pressure within the tunnel is approximately 3-7mm Hg. CTS can result in pressure with greater than 30mm Hg.
🌀Symptoms include:
1⃣ Wrist pain, particularly at night
2⃣ Weakness of the hand and thumb
3⃣ Difficultly grasping objects
4⃣ Pain radiating up into the elbow
5⃣ Swelling ad stiffness
🔴Diagnosis
◾X Rays
◾MRI
◾Ultrasound
◾EMG
🔴Special Test ❗
◾Carpal compression test
◾ Phalen's test and Reverse phalen's test
◾ Tinel's test
◾Square sign test
🔴Questionnaires❓❓
1) Boston Carpal Tunnel Questionnaire (BCTQ)
2) Disability of Hand and Shoulder (DASH) Questionnaire
3) Brigham and Women's Carpal Tunnel Questionnaire
⬛🔷🔹Physical therapy management🔹🔷⬛
💢➖Wrist Extension Stretch
Hold one arm straight out in front of the body at shoulder height.Try not to lock the elbow when stretching the arm out.Bend the wrist back as if making a “stop” sign.Use the opposite hand to gently pull the palm back toward the body to feel a stretch in the inner forearm.Hold for 15 seconds.
Release and repeat five times.
Repeat the whole exercise on the other arm.
💢➖Wrist bend(forward and back)
Rest your elbow on a table, arm pointing up, wrist straight.Gently bend your wrist forward at a right angle and hold for 5 seconds.Straighten your wrist.Gently bend it backwards and hold for 5 seconds.Do 3 sets of 10 repetitions.
💢➖Wrist lift
Place your palm on the table and lift the fingers up.Place your other hand across the knuckles at 90º and push down as the bottom hand tries to pull up.You should feel the muscles of your forearms contracting.
Swap hands and repeat.
💢➖Prayer stretch
Start with your palms together in front of your chest just below your chin.
Slowly lower your hands toward your waistline, keeping your hands close to your stomach and your palms together until you feel a mild to moderate stretch under your forearms.Hold for at least 15 to 30 seconds. Repeat 2 to 4 times.
💢➖Thumb Stretch
Using your opposite hand, push your thumb backward until you feel a gentle stretch. Repeat up to four times.
💢➖Wrist flex
Keeping your arm straight in front with your palm facing down, gently bend your wrist down.Use the opposite hand to press the stretching hand back towards your body and hold for 15–30 seconds.Straighten your wrist.
Gently bend the stretching hand backwards and use the opposite hand to pull the fingers back.Hold for 15–30 seconds.Do 3 sets with each wrist.Holding a light weight (e.g a tin of beans), stretch your arm out in front with your palm down.Made and Composed by Dr Hashim Khan Physio Care Clinic Taunsa
💢➖Wrist stretch with weight
Slowly bend your wrist upward, and then return to the starting position.Do 3 sets of 10 repetitions.Gradually increase the weight you hold.
💢➖Hand Ball squeeze
Squeeze a rubber ball and hold for 5 seconds.
Do 3 sets of 10 repetitions.
💢➖Nerve Glides
Make a fist and bend your wrist towards your shoulder on your bad side, side bend your head away. Then press your palm away and bend your head towards the bad side. Move within a comfort zone and repeat 15 times.
📱💻🖱Ergonomic advice
Rectifying any issues surrounding work-station setup, or other repetitive lifestyle habits may help to reduce aggravation of CTS. Common factors to look out for may be desk, seat or monitor height, mouse use, or even the use of a standing desk to alter positions more regularly.
💆🏻💆🏻Massage therapy:
Massage therapy includes compression, cross-fiber function, deep tissue work, stretching, and trigger point. This therapy reduces pain, improves grip strength, and makes muscles more flexible
❄❄ Cryotherapy:❄❄
Ice therapy can be used by applying ice to the wrist for 10- 15 minutes once or twice an hour.It will reduce swelling and pain.
⚡⚡⚡Electrotherapy⚡⚡⚡
🌞Thermal procedures –
These therapy approaches apply exogenous heat to reduce stiffness, relax muscles, ease sensations, improve nervous conduction, and boost regeneration. The most common modalities include paraffin wax bath and ultra high frequency therapy.
☀Laser therapy –
This FDA-approved treatment can reduce pain and burning sensations in patients with carpal tunnel syndrome.
🌟Ultrasound therapy –
Ultrasound therapy is used to break the adhesions, increase circulation and improve range of motion by using its fibrinolytic, anti-inflammatory, and anti-irritant action of the ultrasound.
⭐Magnetotherapy :
– This type of treatment is often prescribed before electrotherapy because it improves the therapeutic benefits. Magnetotherapy stimulates healing processes, which could help with symptoms.
⭐TENS/ EMS:
can improve nerve conduction, reducing carpal tunnel syndrome symptoms like pain and stiffness.
⭐Iontophoresis:
Iontophoresis is also found to be effective as a treatment of carpal tunnel syndrome.
✔✔Orthotic management
Splint/Brace
Wearing a resting splint can help prevent the symptoms occurring at night, or a working splint can be useful if your symptoms are brought on by particular activities
Swelling management
🧤Compression gloves and other techniques to reduce swelling may be required, depending on the cause of your symptoms.
💊Medication:
NSAIDS,
Diuretics,
Oral steroids,
🔹Supplemental treatment
Vitamin B6 (Pyridoxine) is often used as a conservative and adjunct therapy in treatment of carpal tunnel syndrome. Many patients attempt to treat their symptoms with vitamin B6 on their own.
💉Corticosteroid Injection
Corticosteroid injections done under ultrasound are commonly used in the management of carpal tunnel syndrome. The aim of the injections is to reduce swelling. By doing this more space is created between the median nerve and muscle tendons which reduces the compressive stress placed on the nerve.
⚔Surgery
The main surgical procedure for carpal tunnel syndrome is a carpal tunnel release or decompressive surgery. Again, the aim is to create as much space for the median nerve to travel through the carpal tunnel to reduce the stress placed upon it. Both surgical and non-surgical options have been shown to be effective in the management of carpal tunnel syndrome
