“The Effectiveness of Manual Therapy on Pain, Physical Function, and Nerve Conduction Studies in Carpal Tunnel Syndrome Patients: A Systematic Review and Meta-Analysis”; Jiménez-Del-Barrio, S., Cadellans- Arróniz, A., Ceballos-Laita, L., Estébanez-de-Miguel, E., López-de-Celis, C., Bueno-Gracia, E., Pérez-Bellmunt, A.; International Orthopaedics , February, 2022 Summary : This systematic review and meta-analysis evaluated the effectiveness of manual therapy in improving symptoms, physical function, and nerve conduction in carpal tunnel syndrome (CTS) patients. Databases including MEDLINE, Web of Science, SCOPUS, Cochrane Library, TRIP, and PEDro were searched until September 2021 for randomized controlled trials. Out of 81 potential studies, six involving 401 patients met the criteria. The results showed
significant improvements: Pain intensity (SMD–2.13), symptom severity (SMD –1.67), functional status (SMD –0.89), motor nerve conduction (SMD –0.19), and sensory nerve conduction (SMD –1.15). The study concludes that manual therapy techniques, particularly soft tissue and neurodynamic mobilizations, are effective in treating CTS. Summary of research recommendations: ● Swedish (classic) massage ● Trigger point therapy ● Madenci massage technique ● Soft tissue mobilization ● Neurodynamic technique ● Ultrasound therapy coupled with massage therapy ● Targeted carpal tunnel massage protocols
DIFFERENTIAL DIAGNOSIS
Carpal tunnel syndrome is often confused with other conditions that manifest themselves in similar expected signs and symptoms. Thoracic outlet syndrome, Guyon’s canal syndrome, radial nerve impingement, pectoralis minor Phalen’s test In Phalen’s test, the client presses the dorsal surfaces of the hands together in front of themselves with their wrists flexed as much as possible. This position is held for up to 60 seconds. The classic signs of CTS will manifest with this test if the condition is present. For true CTS patients, acute pain and sensation is felt within 5 seconds. This test can also be performed in reverse position (e.g., with wrists extended; Cleveland Clinic, 2023. Finger loop test In the finger loop test, the client interlocks the index finger and the thumb in opposite positions. The client presses their fingers against each other to hold this interlocked position. Allen’s test In Allen’s test, the therapist compresses both the radial and the ulnar arteries with a firm pressure, thereby occluding blood flow. For 30 seconds, the client makes a fist several times. After 30 seconds, the therapist releases pressure from the ulnar artery to witness a restoration of blood flow. The therapist then reapplies pressure on the ulnar artery while releasing pressure off the radial artery for a restoration of Finkelstein test In the Finkelstein test, the client places the thumb within their fist, then ulnar deviates the hand. This motion stretches the abductor pollicis longus and flexor pollicis longus tendons. If sharp pain results, this indicates De Quervain’s Tinel’s sign The practitioner lightly taps upon the carpal tunnel within the client’s palm. Recreation of CTS symptoms indicates Non-surgical treatments include the following (Sharma, 2021) : ● Wrist splinting and bracing : These will provide temporary relief and protection of joints that do not receive adequate rest. Some clients simply cannot take off several weeks from work to heal fully, which would be ideal. Hence, bracing allows these clients to continue working through their CTS symptoms (Ashworth, 2024). ● NSAIDs (nonsteroidal anti-inflammatory drugs) : Common NSAID drugs include aspirins, Celebrex, Cambia, Motrin, Advil, Indocin, Daypro, Aleve, Anaprox,
syndrome, frozen shoulder, and subscapular impingement are all conditions easily mistaken or deemed “carpal tunnel” by health professionals.
Healthcare Consideration: A positive indication with Phalen’s test performed with the wrist flexed indicates a bone/joint displacement injury. A positive indication with Phalen’s test performed with wrists extended indicates a myofascial-related challenge to address with the CTS patient.
If a client cannot maintain this locked position with firm pressure application (as if to pull the fingers apart), carpal tunnel syndrome is indicated.
blood flow. Failure to witness a restoration of blood flow to the hand indicates myofascial restrictions along either the radial or the ulnar sides of the antebrachium. Note: The therapist could release pressure from the radial artery prior to releasing ulnar artery pressure with no consequence to the testing (Zisquit et al., 2022).
tenosynovitis. Feeling a stretch of these pollicis tendons is expected; pain that radiates proximally upon the forearm is not a natural occurrence (Som et al., 2023)
a positive indication for carpal tunnel syndrome (Lesher, 2018).
TREATMENTS
and Feldene. Common side effects of NSAIDs are gastrointestinal challenges, headaches, high blood pressure, tinnitus, headaches, dizziness, and stomach ulcers. ● Corticosteroids : Common examples include Celestrone, Intensol, Prednisone, Orapred, Prelone, Medrol, Depo- Medrol, and DexPak varieties. Common side effects include weight gain; swelling of the joints, face, and body; easy bruising; impaired immunity; blurry vision; muscle weakness; mood swings; gastrointestinal challenges; and acne.
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Book Code: MGA1226
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