Chapter 1: Carpal Tunnel Syndrome: A Comprehensive Guide for Massage Therapists 1 CEU
By: Jimmy Gialelis, LMT Learning objectives Identify anatomical structures involved with carpal tunnel syndrome and similar conditions. Delineate “true” carpal tunnel syndrome from other similar conditions. Implicit bias in healthcare Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes. Addressing 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 seven inches for the average female body stature and eight inches for the average male body stature. Wrist circumference less than six inches for females and less than seven inches for males make one more susceptible to experience carpal tunnel syndrome. There are numerous joint classifications used to describe the articulations of the carpal bones. Most synovial joint spaces witnessed in this region are gliding joint surfaces, 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. Medial to lateral: Proximal row ● Scaphoid. ● Lunate. ● Triquetrum. ● Pisiform. Medial to lateral: Distal row
Recognize research that indicates the effectiveness of massage therapy for carpal tunnel syndrome patients. Perform bodywork techniques designed to reduce the signs and the symptoms of carpal tunnel syndrome. implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
ANATOMY OF THE REGION
“She Looks Too Pretty, Try to Catch Her. ” Another 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
● Trapezium. ● Trapezoid. ● Capitate. ● Hamate.
Medical school students use a variety of mnemonics (acronym phrases to recall lists) to memorize the eight carpal bones. These include: “So Long to Pinky, Here Comes the Thumb.”
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Book Code: MLA1224
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