● Manual therapy : Research included in this course highlights the effectiveness of manual therapy efforts to relieve pain and related symptoms of CTS. ● Yoga : Certain poses (asanas) can strengthen the upper body joints, which will aid in reducing the risk of injury and other causes of carpal tunnel syndrome (Ashworth, 2024). ● Hand therapy: Exercises designed to strengthen the antebrachium and hand muscles will reduce the risk of injury and other carpal tunnel syndrome. Physical therapists and occupational therapists can specialize in hand therapy to help conditions such as CTS. Surgical treatments Surgical treatments are generally recommended if the clinical presentation of carpal tunnel syndrome persists for more than six months. Surgical treatments include the following (John Hopkins Medicine, 2021): ● Endoscopic surgery : A tiny camera guides the surgeon toward the retinaculum and carpal tunnel region to locate a proper incision location. ● Open surgery : A large incision is made through the palm, which opens the entire tunnel to locate proper space to repair damage or to loosen restrictions of the retinaculum.
Surgeries typically need to be performed every 5 to 10 years, depending on the efficacy of the carpal tunnel surgery. Common side effects of surgical treatments include: ● Nerve damage due to lesions that present along the median nerve and surrounding tissue structures ● Joint stiffness due to connective tissue adhesions resultant from incisions ● Pain at the surgical scar (usually subsides in four to six weeks) ● Infection due to pathogenic agents entering the incision site ● Loss of strength as nerve supply interruptions occur, either consistently or intermittently According to Ben Said and colleagues (2023), approximately 89% of patients return to their same jobs after surgery. Also, endoscopic procedures generally lead to faster recovery times than open procedures, yet may have with more potential complications. A 2022 study discovered an improvement in sensory conduction of the median nerve in CTS patients after surgical procedures (Erfanifam et al., 2022).
THERAPIST APPLICATION RECOMMENDATIONS
This section describes recommended strokes to perform on a carpal tunnel patient within a therapeutic massage session. Any rehab therapist can choose to employ any (or all) of
these techniques. These recommendations will address the classic CTS signs and symptoms along the pathway of the median nerve (Biel, 2019).
Freeing the elbow Figure 6: Warm up on Brachium
Good strokes to use when warming up tissue (Figure 6) include effleurage, friction, and petrissage. Warming up any tissue before therapeutically addressing it avoids injury potential, allows the therapist to ascertain tissue quality, and gauges the client’s comfort level.
Figure 7: Pulling Petrissage upon Biceps Brachii
With your outside hand, lift and secure the arm in a 90-degree manner from the torso (see Figure 7). With your inside hand: 1. Create a crescent shape (cupped shaped hand as in holding an aluminum can). 2. Grasp the biceps brachii muscle firmly, leaving no space between the therapist’s hand and client’s muscle. 3. Lift the biceps brachii muscle and mobilize in a direction toward the pinky side of the hand. As the therapist, ensure that you are moving your whole arm, not only your wrist. 4. Repeat this movement several times without creating space between the hand and the muscle. Move along the entire muscle from distal to proximal.
Figure 8: Pressing Petrissage upon Brachialis
Move along the biceps brachii laterally with straight fingers, then firmly plant fingers deeply toward the distal end of the humerus bone (see Figure 8). The thick mass of muscle felt on the bone is the brachialis muscle. Slow, nongliding movements are enough to stimulate these fibers. Moving superior–inferior will allow for longitudinal strokes; moving medial–lateral will perform cross-fiber strokes.
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Book Code: MGA1226
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