Physical examination ● General: The patient was in no acute distress. ● Neurological examination: ○ Sensation: Decreased sensation to light touch and pinprick in the distribution of the median nerve in the right hand (thumb, index, middle, and radial half of the ring finger). ○ Motor: Weakness of the abductor pollicis brevis muscle on the right. ○ Reflexes: Reflexes were normal. ● Special tests: ○ Phalen’s Test: Positive on the right side, with reproduction of symptoms after one minute of wrist f lexion. ○ Tinel’s Sign: Positive on the right side, with tingling in the median nerve distribution upon tapping the carpal tunnel. Diagnostic studies ● Nerve conduction studies (NCS): Demonstrated prolonged distal motor latency and reduced sensory conduction velocity in the right median nerve. ● Electromyography (EMG): Showed evidence of denervation in the muscles innervated by the median nerve. Diagnosis Based on the clinical presentation, physical examination, and diagnostic studies, the patient was diagnosed with carpal tunnel syndrome (CTS) in the right hand. Management and treatment Conservative treatment: ● Activity modification: Advised to take frequent breaks during typing and use ergonomic keyboards and mouse. ● Wrist splints: Recommended wearing a wrist splint, especially at night, to keep the wrist in a neutral position. ● Physical therapy/occupational therapy: Referred to a physical/occupational therapist for nerve gliding exercises and education on proper hand mechanic. ● Massage therapy: Included in her treatment plan to reduce muscle tension and improve circulation in the wrist and forearm; she received regular sessions focused on the forearm, wrist, and hand muscles, which provided some symptomatic relief. Conclusion Surveying the research conducted on carpal tunnel syndrome indicates that this condition greatly affects the general population. It manifests itself in a wide variety of characteristics, and massage therapy efforts may aid the carpal tunnel patient. Age, the repetitive nature of one’s occupation, and sleep positions are strongly correlated to the development of carpal tunnel syndrome. Orthopedic assessment testing may provide a therapist with a clearer clinical picture of their patient’s carpal tunnel case. Bodywork suggestions presented in this course will provide great relief and enhance treatment plans. Recommending self-care efforts to the carpal tunnel patient will augment therapy.
Medical management: ● NSAIDs: Prescribed nonsteroidal anti-inflammatory drugs for pain management. ● Corticosteroid Injection: Administered a corticosteroid injection into the carpal tunnel, which provided temporary relief. Surgical intervention Due to the severity of symptoms and the lack of significant improvement with conservative measures, Mary was referred to an orthopedic surgeon for evaluation. After a thorough discussion of the risks and benefits, she opted for surgical intervention: ● Carpal tunnel release surgery: The patient underwent an endoscopic carpal tunnel release surgery. The transverse carpal ligament was cut to relieve pressure on the median nerve. Follow-up and outcome Mary had a postoperative follow-up one week after surgery and then at one, three, and six months. Her symptoms gradually improved, with a significant reduction in pain, numbness, and tingling. She regained strength in her hand and was able to return to her normal activities and work without difficulty. At the six-month follow-up, Mary reported complete resolution of symptoms and expressed satisfaction with the outcome of the surgery. She was advised to continue ergonomic practices and exercises to prevent recurrence. Discussion Carpal tunnel syndrome is a common entrapment neuropathy caused by compression of the median nerve within the carpal tunnel. Risk factors include repetitive hand movements, prolonged use of vibrating tools, and certain medical conditions such as diabetes and hypothyroidism. Diagnosis is primarily clinical, supported by nerve conduction studies and electromyography. Management includes conservative measures such as wrist splints, activity modification, massage therapy, and physical/occupational therapy, with surgical intervention reserved for refractory cases. Early diagnosis and appropriate management are crucial to prevent permanent nerve damage and functional impairment. This case highlights the importance of a comprehensive approach to treatment, incorporating both nonsurgical and surgical options, including massage therapy, to achieve optimal patient outcomes. Information presented is never intended to replace advice from a qualified medical professional. Please honor all requests of the physician and practitioners in the care of one’s health condition.
WORKS CITED https://qr2.mobi/carpal-tunnel
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Book Code: MFL1227
EliteLearning.com/Massage-Therapy
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