Effective Intervention Strategies to Promote Occupational Performance Among Individuals with Carpal Tunnel Syndrome Madalyn Payne, OTS

Identification of Topic Level II Fieldwork Ireland Army Community Hospital, Fort Knox, KY Carpal Tunnel Syndrome in today’s society My mother

Carpal Tunnel Syndrome Compression of median nerve Numbness, tingling, pain Sensory nerve distribution Motor distribution Most common nerve entrapment

How is it diagnosed? Subjective statements Provocative tests Tinels Phalens EMG/Nerve conduction study

Occupational Performance! Why do we care? Occupational Performance! CTS can greatly effect a person’s occupational performance. The numbness, tingling, and pain associated with CTS can cause a decrease in occupational performance. ** anecdote: Patient that I treated while at clinicals waited too long to seek treatment for CTS and she was starting to drop items that she was holding and did not have any control over her grip.

Evidence-Based Treatments Tendon and nerve gliding exercises

Evidence-Based Treatments Massage techniques Ischemic compression CTS targeted Soft tissue mobilization Graston Instrument Deep tissue massage to release trigger points to help increase blood flow to increase healing among the proximal UE where median nerve can be entrapped

Evidence-Based Treatments Splinting combined with lumbrical stretches

Evidence-Based Treatments Full time splinting and formal education Ketoprofen phonophoresis combined with splinting Wrist cock-up splint; formal education included classes on self-management to teach causes of CTS and ways to prevent such as decreasing repetitive movements Using ultrasound with steroid medication to decrease inflammation to decrease compression of median nerve

Clinical Implications for OT Conservative treatment options to prevent/prolong surgery All have been shown to decrease signs and symptoms Treatment post-surgery Scar management ROM Occupation-based treatments Need is only going to increase Getting back to function!!

References Burke, J., Buchberger, D. J., Carey-Loghmani, M. T., Doughtery, P. E., Greco, D., & Dishman, D. (2007). A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. Journal of Manipulative and Physiological Therapeutics, 30(1), 50-61. doi: http://dx.doi.org/10.1016/j.jmpt.2006.11.014 Hains, G., Descarreaux, M., Lamy, A., & Hains, F. (2010). A randomized controlled (intervention) trial of ischemic compression therapy for chronic carpal tunnel syndrome. Journal Of The Canadian Chiropractic Association, 54(3), 155-163. Horng, Y., Hsieh, S., Tu, Y., Lin, M., Horng, Y., & Wang, J. (2011). The Comparative Effectiveness of Tendon and Nerve Gliding Exercises in Patients with Carpal Tunnel Syndrome: A Randomized Trial. American Journal Of Physical Medicine & Rehabilitation, 90(6), 435-442. doi:10.1097/PHM.0b013e318214eaaf Moraska, A., Chandler, C., Edmiston-Schaetzel, A., Franklin, G., Calenda, E. L., & Enebo, B. (2008). Comparison of a Targeted and General Massage Protocol on Strength, Function, and Symptoms Associated with Carpal Tunnel Syndrome: A Randomized Pilot Study. Journal Of Alternative & Complementary Medicine, 14(3), 259-267. doi:10.1089/acm.2007.0647 Nancy A. Baker, Krissy K. Moehling, Elaine N. Rubinstein, Ronit Wollstein, Norman P. Gustafson, Mark Baratz, (2012). The Comparative Effectiveness of Combined Lumbrical Muscle Splints and Stretches on Symptoms and Function in Carpal Tunnel Syndrome, Archives of Physical Medicine and Rehabilitation, Volume 93, Issue 1, January 2012, Pages 1-10, ISSN 0003-9993, http://dx.doi.org/10.1016/j.apmr.2011.08.013

Questions Any questions/comments about CTS research? Other comments/suggestions…

Madalyn Payne, OTS mpayne@spalding.edu Contact Information Madalyn Payne, OTS mpayne@spalding.edu