Chapter 5: Carpal Tunnel Syndrome: A Comprehensive Guide for Manual Therapists 2 CE Hours
By: Jimmy Gialelis, LMT, BCTMB Course overview This course is designed to equip learners with the knowledge and skills necessary to effectively differentiate, analyze, and treat carpal tunnel syndrome (CTS) using evidence-based manual techniques. By the end of this course, learners will be well versed in the anatomical, diagnostic, and therapeutic aspects of CTS, enabling them to provide targeted and effective care to their patients. This Learning objectives After completing this course, the learner will be able to: Differentiate anatomical structures involved with carpal tunnel syndrome and similar conditions. Differentiate diagnosis of carpal tunnel syndrome from other similar conditions.
course is ideal for manual therapy healthcare professionals, including massage therapists, physical therapists, athletic trainers and occupational therapists, who wish to expand their expertise in treating upper extremity disorders, particularly those involving nerve compression and musculoskeletal issues. This course will provide valuable insights and techniques to enhance therapeutic practice. Analyze research that indicates the effectiveness of manual therapy and other intervention techniques for carpal tunnel syndrome patients. Predict techniques designed to reduce the signs and the symptoms of carpal tunnel syndrome and improve occupational performance for patients.
ANATOMY OF THE REGION
A good mnemonic includes recalling that the carpals are located within the manus region, whereas the tarsals are located within the pes region. ● Drive a CAR with your carpals and walk on TAR with your tarsals. Another easy way to learn the locations of the carpal bones is to divide the bones into functional zones in relation to nearby nerves and bones: ● The radial column , aligned with the radial nerve and radius bone, contains the scaphoid, trapezium, and trapezoid bones. ● The median column , aligned with the median nerve, is bounded by the lunate and capitate bones. ● The ulnar column , aligned with the ulnar nerve and ulna bone, contains the triquetrum, pisiform, and hamate bones. The pisiform bone is referred to as a sesamoid bone, meaning it is a bone without a direct articulation with another bone. In this case, the pisiform bone is embedded into the tendon of flexor carpi ulnaris muscle. An injury to this tendon can result in a deviation in the positioning of the pisiform bone, leading to ulnar nerve compression. Figure 1: Carpal Bones
The carpal tunnel region contains eight bones articulated in tight proximity; cartilaginous structures, called articular discs, help bind these bones. The average wrist circumference that encompasses the carpal tunnel region is 7 inches for the average female body stature and 8 inches for the average male body stature. Wrist circumference less than 6 inches for females and less than 7 inches for males make one more susceptible to carpal tunnel syndrome (Netter, 2022). Numerous joint classifications are used to describe the articulations of the carpal bones. Most synovial joint spaces in this region are gliding joint surfaces, which are also called plane joint surfaces. Since there is no rotation of the bones in this area, the joints are considered nonaxial. The sliding movement is like rubbing one’s hands together for warmth in a straight-line fashion. Of note to manual therapists, the joint articulating the trapezium bone to the first metacarpal bone is a saddle joint. This is a modified ellipsoid joint due to the convex/concave shapes joining together. Because this joint provides rotational movement in two planes, it is considered a biaxial joint. The eight bones can easily be listed by their location in their respective rows, proximal or distal, and by directional placement, medial versus lateral (Netter, 2022). Lateral to medial: Proximal row ● Scaphoid ● Lunate ● Triquetrum ● Pisiform Lateral to medial: Distal row ● Capitate ● Hamate Medical school students use a variety of mnemonics (acronym phrases to recall lists) to memorize the eight carpal bones. These include: ● Trapezium ● Trapezoid
● So Long to Pinky, Here Comes the Thumb ● She Looks Too Pretty, Try to Catch Her
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Book Code: MFL1227
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