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 Pains & Aches

March 2012
Physiotherapy for CTS
Dr Vijay Krishna
 
In the normal skeletal structure of our hands, the carpal bones or wrist bones form a tunnel to give way to the tendons, ligaments and median nerve. A clinical condition arising from the compression of the median nerve at the wrist joint is called Carpal Tunnel Syndrome (CTS).

The symptoms can range from pain and immobility to swelling.

What is the role of median nerve?
Median nerve supplies movement and sensation to half of the palm, thumb, index and half of the ring finger.

Special test for CTS
Phalen’s manoeuvre: The person with CTS symptoms is made to either sit or stand. Dorsal sides of both the hands are compressed to each other for a stretched feeling. If in the process the person experiences tingling and pain all through to the elbow, the test is positive for CTS.

Physiotherapy
  • RICE (Rest Ice Compression and Elevation)
  • Applying ice relieves pain
  • Compression allows the prevention of further damage and also helps in reducing swelling
  • Elevation - helps in reducing swelling
  • Soft tissue massage
  • Electrotherapy – Ultrasound by physiotherapist
  • Splinting – night splints or at work place
  • Stretching exercises for the muscles of the forearm. Pain-free flexibility exercises are to be incorporated into the regime: l Wrist flex or stretch l Wrist and finger extensor stretch
  • A range of pain-free motion exercises: l Wrist flexion to extension l Forearm rotation l Side bends of wrist
  • Isometric exercises without lengthening the muscle fibres: Strength is acquired by increasing the tone of that particular set of muscles.
  • Progressive resistance exercises: Exercises for the wrist and hand are strengthened using Theraband / stretch bands
  • Training and activity modification advice leading to implementation of ergonomic sessions at the workplace.
  • Return to activity plans to be designed in discussion with a physiotherapist – totally dependent on the progression of the condition
Remember if the physiotherapy is not found beneficial, the patient suffering from CTS is advised to undergo a few medical or surgical treatments too.

Treatment
  • Forearm stretches
  • Isometric exercises – taught after the swelling has decreased
  • Progressive strengthening exercises - resistance band exercises
  • Wearing a wrist splint that prevents flexion – the aim is to immobilise and
    prevent further damage
  • Localised Corticosteroid injections


    
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