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 ○ 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. 2. NSAIDs (Non-steroidal anti-inflammatory drugs) ○ Common NSAID drugs include typical 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. 3. Corticosteroids ○ Common examples include Celestrone, Intensol, Prednisone, Orapred, Prelone, Medrol, Depo-Medrol, and DexPak varieties. Treatments Non-surgical treatments include : 1. Wrist splinting and bracing ○ Common side effects include weight gain, swelling of the joints, face, and the body, easy bruising, impaired immunity, blurry vision, muscle weakness, mood swings, gastrointestinal challenges, and acne. In a feature article in Practical Therapeutics , a Jacksonville, Florida naval hospital practitioner published findings of drug- related treatments for CTS patients. His findings indicated that only NSAID and corticosteroid drugs showed significant short-term effectiveness for patients, and that vitamin B6 and diuretic treatments were no more effective than placebo in these same patients. 4. Massage therapy ○ Research included in this course highlights the effectiveness of massage therapy efforts to relieve pain and related symptoms of CTS. This next section describes recommended strokes to perform on a carpal tunnel patient within a therapeutic massage session. A therapist can choose to employ any (or all) of these techniques. Freeing the elbow Good strokes to use when warming up tissue (Figure 6) include effleurage, friction, and petrissage. Warming up any tissue before therapeutically addressing tissue avoids injury potential, allows the therapist to ascertain tissue quality, and gauges the client’s comfort level. Figure 6: Warm Up upon Brachium
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. Surgical treatments are generally recommended if the clinical presentation of carpal tunnel syndrome persists for more than six months. Surgical treatments include: ● 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 five to ten years, depending on the efficacy of the carpal tunnel surgery. Further, 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 incision site. ● Loss of strength as nerve supply interruptions occur, either consistently or intermittently. Research spanning 2002 to 2006 (Chow, J; Thomas, A; McNally, S; Schmelzer, R; Park S; Quaglietta, P) indicates that 90% of patients return to their same jobs after surgery. Also, endoscopic procedures generally lead to faster recovery times than open procedures, yet may present with more potential complications. Researchers David Coggin and Keith Palmer’s study (2013) published in BMC Musculoskeletal Disorders discovered an improvement in sensory conduction scores of the median nerve in CTS patients after surgical procedures.
THERAPIST APPLICATION RECOMMENDATIONS
These recommendations will address the classic CTS signs and symptoms along the pathway of the median nerve.
With your outside hand, lift and secure the arm in a ninety- degree manner from the torso (see Figure 7). With your inside hand: 1. Create a crescent shape (Cupped shape 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.
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Book Code: MLA1224
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