“Comparison of a Targeted and General Massage Protocol on Strength, Function and Symptoms associated with Carpal Tunnel Syndrome: a randomized pilot study”; Moraska, A., Chandler, C., Franklin, G., Edmiston-Schaetzel, A., Calenda, EL., Enebo, B.; Journal of Alternative and Complimentary Medicine, April 2008. Abstract Carpal Tunnel Syndrome (CTS) is a major, costly public health issue that could be dramatically affected by the identification of additional conservative care treatment options. Our study aimed to evaluate the effectiveness of two distinct massage therapy protocols on strength, function and symptoms associated with CTS. This was a randomized pilot study design with double pre- tests and subjects blinded to treatment group assignment. The setting for this study was a wellness clinic at a teaching institution in the United States. Twenty-seven subjects with a clinical diagnosis of CTS were included in the study. Subjects were randomly assigned to receive 6 weeks of twice weekly massage consisting of either a general (GM) or CTS targeted TM massage treatment program. Dependent variables included hand grip and key pinch dynamometers, Levine symptom and function evaluations, and the Grooved Pegboard test. Evaluations were conducted twice during baseline, 2 days after the 7th and 11th massages and at follow up visit 4 weeks after the 12th treatment. A main effect of time was noted on all outcome measures across the study time frame (P < 0.001). Improvements persist at least 4 weeks post treatment. Comparatively, TM resulted in greater gains in grip strength than GM (P = 0.04) with a 17.3% increase over baseline (P < 0.001) but only a 4.8% gain for the GM group (P = 0.21) significant improvement in grip strength was observed following the 7th massage. No other comparisons between treatment groups attained statistical significance. Both the GM and TM treatments results in improvement of subjective measures associated with CTS, but improvement in grip strength was only detected with the TM protocol. Massage therapy may be a practical conservative intervention for compression neuropathies such as CTS, although additional research is needed. 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.
ultrasound therapy combined with massage and kinesiotherapy for carpal tunnel syndrome. A total of 61 patients were assessed with regard to such symptoms as pain, numbness, tingling sensation, morning stiffness and self-care difficulties. We used provocation tests and investigated sensory impairments, autonomic disturbances and Luthy sign. Conduction in the median nerve fibers was assessed during a nerve conduction study. We performed computer-aided measurement of the hand joint range of motion and global grip strength. The tests were conducted before and on completion of rehabilitation program. The hands were re-examined one year later. The treatment involved ultrasound therapy, massage and kinesiotherapy. The treatment outcomes confirmed the effectiveness of the therapeutic program. Significant improvements concerning the majority of the symptoms were observed between the first and second examination as well for the entire follow up period. We observed significant improvement in the quality of sensation, the hand range of motion and muscle strength. Ultrasound therapy combined with massage and kinesiotherapy brings the expected, long term effects of patients with carpal tunnel syndrome. “Evaluating the Pain Management Methods of Patients with Carpal Tunnel Syndrome”; Kizilcik-Ozkan Z., Unver S., Basar A.; Journal of the Turkish Society of Algology, October 2016 Abstract This study sought to evaluate pain severity and pain management methods of patients with carpal tunnel syndrome. This descriptive study was conducted with patients who were diagnosed with carpal tunnel syndrome (n=99) in the neurology clinic of the university hospital between August 2014 and December 2015. Patient data form, visual analog scale (VAS) and a pain management inventory were used to collect data. Of the total, 64.6% of the patients experienced pain. Patients used prescription medication, massage and exercise to control pain, and reported that the most useful method was exercise followed by massage and finally prescription medication. Healthcare professionals may share the findings of the relative benefit according to method of pain management and encourage patients to use non-pharmacological methods.
DETERMINING IF A CLIENT HAS “TRUE” OR “FALSE” CTS
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 syndrome, frozen shoulder, and subscapular impingement are all conditions easily mistaken or deemed “carpal tunnel” by health professionals. Phalen’s test In Phalen’s test, the client presses the dorsal surfaces of the hands together in front of him/herself with his/her 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 five seconds. This test can also be performed in reverse position (e.g. with wrists extended). Note: 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. Finger loop test In the finger loop test, the client interlocks the index finger and the thumb in opposite positions. The client presses his/her fingers against each other to hold this interlocked position. If
a client cannot maintain this locked position with firm pressure application (as if to pull the fingers apart), carpal tunnel syndrome is indicated. 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 will make a fist several times. After 30 seconds, therapist releases pressure off 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 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 off the radial artery prior to releasing ulnar artery pressure with no consequence to the testing. Finkelstein test In the Finkelstein test, the client places the thumb within his/ her 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 tenosynovitis. Feeling a stretch of these pollicis tendons is expected; pain that radiates proximally upon the forearm is not a natural occurrence.
Page 23
Book Code: MTX1323
EliteLearning.com/Massage-Therapists
Powered by FlippingBook