Carpal Tunnel Syndrome

[Gajba]

Hi,

I am interested in treatment (protocol) for Carpal Tunnel Syndrome.
My patient is thirty years old women. She cannot rest her wrist (she is finishing her book and working with computer mouse is necessary).
So, I gave her stretching exercise (in flexion and extension with extended fingers), I didn't do any NAGS/SNAGS because I couldn't find movement with pain and I told her how to do ice massage (if that will decrease pain when pain appears).
In addition, I suggest to her to use a gloves and to take many breaks with exercises...

Any better ideas?

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[alophysio]

?Night Splints?/resting splints?

?Ergonomic wrist supports?

[Gajba]

She is using ergonomic wrist support, and I forgot night splint

Thanx

[somasimple]

Hi,

You took the good decision about splints. It decreases sometimes pain but maintains problems et does not solve them.

[alophysio]

yes that's true but the short term goal is to enable the client to continue writing until the current task is complete. Hence any helpful pain-relief, even if it doesn't solve the problem is going to be better than none since the client is going to continue banging away at a keyboard for the forseeable future. 30mins at physio is nothing compared to >8-12hrs in front of a computer screen.

Presumably, the client will then take the time to sort out the problem...

[somasimple]

Hi,

If the short term goal is work then it is preferable to look at possible cervical problems and make neuromobilizations (Butler/Shacklock). It decreases pain quickly and permits patients to return at work in few weeks.

[sdkashif]

Have a look over some useful studies.

Iontophoresis, wrist splinting.

A review of conservative treatment of CTS

Manipulative management of carpal tunnel syndrome.

Some risk factors for CTS

[Gajba]

Thank you!

[angela929]

As someone has mention before, I believe that the neuromobilization execrise is quite effective for these kind of patient in my option. By the way, you can also use neurotension test as a treatment technique !!!! Hope it can help you!!!

[neving]

how about a different approach - how about a voice program for the computer, so she can dictate rather than type?
neving

[sidney43]

night splints are good - hand must be in slight wrist flexion, NOT in the functional position of slight extension. Also as it is exacerbated by swelling in the carpal tunnel, teach her drainage massage for the upper limb and tell her to ice it regularly. If she puts the mouse down by her side on a stool so that the hand can work in slight flexion that might help too.

[sdkashif]

Let us have a concise review over the management of CTS.

Modalities:

The use of modalities can be given to reduce swelling and pressure within the carpal tunnel. They of great benefit in improving the condition. Ice, ultrasound, iontophoresis, phonophoresis, LASER can be used with great success.

Stretching and Strengthening:

A specific strengthening and stretching exercise programme can improve the strenght and dexterity of hand.

Massage, Nerve gliding and Neural Tension:

Massage, nerve gliding and neural tension techniques can be give but their results are unproven and give no real benefit.

Manipulation:

Manipulative techniques used to stretch & manipulate the carpal tunnel give benefit and improve the condition, although they are not widely accepted.

Ergonomic Advice:

Work sit eassessment help to reduce potential excerbating factors (such as poor posture, excessive force).

Wrist Splints:

Patients with mild to moderate CTS respond well to the conservative programme of night time splintting in neutral position for a minimum of 3-4 weeks and is the best evidence based practice in use.