• Friday, June 10, 2011RSS Feed

    New in the Literature: Carpal Tunnel Syndrome (Am J Phys Med Rehabil. 2011;90:435-442)

    For patients with carpal tunnel syndrome, the combination of tendon gliding exercises with conventional treatments may be more effective than nerve gliding exercises with conventional treatments, say authors of an article published this month in American Journal of Physical Medicine and Rehabilitation.

    Patients with carpal tunnel syndrome were randomized into 3 groups. All patients received conventional treatments (splint and paraffin therapy), but group one received additional tendon gliding exercises and group two received additional nerve gliding exercises. Each patient received a package of questionnaires and underwent physical examinations and nerve conduction study of the upper limbs before and after treatment for 2 months.

    Sixty patients were recruited; 53 completed the study. There were significant improvements in symptom severity and pain scale scores in all groups. However, only participants in group one showed significant improvements in their scores on functional status; the Disabilities of the Arm, Shoulder, and Hand questionnaire; and the physical domain of the World Health Organization Quality of Life Questionnaire Brief Version. After adjusting for baseline data, the researchers found significant differences in the functional status scores among the groups. Post hoc analyses detected a significant difference in functional status scores between groups one and two.


    Comments

    How do you mobilize a tendon and not mobilize a nerve?
    Posted by Robert Wojnowski MPT on 6/10/2011 10:36 PM
    In the hand, this can be done for instance when a digital nerve and the flexor tendon has been cut in zone 2 (digit) and repaired. I would talk with the surgeon to learn about the overall repair, if there had to be tension on the nerve to repair it,then I would flex (immobilize PIP joint) the most proximal joint to the nerve repair to lessen it's excursion but excursion (movement) of the tendon could still be done. With today's suture techniques used in flexor tendon repair we are initiating controlled active motion ie, excurion of the tendon from within the first week but advances in nerve repair suturing aren't there yet especially if the nerve has to be shortened to get an adequate repair. That is just one example - the beauty of the hand is multiple joints and structures that need to glide and how controlling one joint can "immobilize" yet allow "mobilization" I hope that helps!
    Posted by julianne howell on 6/11/2011 10:14 AM
    If "conventional" therapy is a splint and Paraffin for carpal tunnel then that is pretty poor therapy in the first place. Results could be much better with some of the treatments we do including the stretching, laser and splints,or sometimes stretching, ultrasound and Iontophoresis. But just splint and Paraffin?
    Posted by J. W. Corwin PT on 6/13/2011 6:51 PM
    excuse me sir,I'm student from Indonesia, i need information abaout CTS . can you give me more information about that, please ! it's very important for me sir .... thanks before
    Posted by Nur Ainy Ramadhan on 10/30/2014 9:03 AM
    When is pain the criteria for surgery? Pain every now and then? a sharp pain every now and then? pain 24 hours a day? pain less than 12 hours a day? Just not sure of the definition of using pain as the criteria for surgery. Any help would be appreciated. Thanks
    Posted by Dorothy on 11/28/2014 10:08 AM
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