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 from the radial artery prior to releasing ulnar artery pressure with no consequence to the testing (Zisquit et al., 2022). 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 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) Tinel’s sign The practitioner lightly taps upon the carpal tunnel within the client’s palm. Recreation of CTS symptoms indicates a positive indication for carpal tunnel syndrome (Lesher, 2018). 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).
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. 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. 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 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 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, 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. ● 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.
TREATMENTS
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).
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Book Code: MIL1226
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