DIAGNOSTIC MODALITIES AND PHYSICAL THERAPY IN PATIENTS WITH CARPAL TUNNEL SYNDROME

  • Darko Bulatović Institute for Rehabilitation, Belgrade, Serbia
  • Dejan Nikolić Faculty of Medicine, University of Belgrade, Belgrade, Serbia and University Childrens Hospital, Belgrade, Serbia
Keywords: Carpal tunnel syndrome, symptoms, signs, diagnostics, physical therapy

Abstract


Carpal tunnel syndrome (CTS) represents one of the most common compressive peripheral neuropathies on the upper extremities, and is characterized by compression of the medial nerve on its way through the carpal tunnel area. The first changes experienced by patients with CTS are sensory and occur mainly at night, and if they are not recognized and treated in time, they progress and become continuously present. Prolonged compression of the medial nerve in the region of the carpal tunnel can lead to permanent damage to this nerve, which can result in the patient losing the ability to distinguish between hot and cold, as well as atrophy of the thenar muscles and difficulty in palmar abduction of the thumb. The diagnosis of CTS is generally made based on the patient's symptoms, clinical history and anamnesis, as well as electrodiagnostic tests. In addition to these methods, provocative tests, nuclear magnetic resonance (NMR) and ultrasound examinations are used in the evaluation of CTS. In patients with CTS, a large number of treatment methods, both surgical and non-surgical, are used in clinical practice. Myofascial massage, ultrasound, interference currents, continuous short-wave diathermy, extracorporeal shock wave therapy (ESWT) have been shown to be beneficial in reducing pain and symptoms or improving function in patients with CTS in the short and medium term. It was also pointed out that there are no firm conclusions about optimal doses and therapeutic parameters. A better understanding of the etiology and pathophysiological mechanisms of CTS as well as the effects of certain therapeutic modalities in the treatment of this condition will contribute to further understanding of the origin and progression of CTS as well as the possibilities of prevention and treatment of these patients in order to improve the quality of their life and the functionality of the affected limb.

References


  1. Aroori S, Spence RA. Carpal tunnel syndrome. Ulster Med J. 2008;77(1):6-17.

  2. Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, et al. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol. 2016;15(12):1273-84. 

  3. Wipperman J, Goerl K. Carpal Tunnel Syndrome: Diagnosis and Management. Am Fam Physician. 2016;94(12):993-99. 

  4. Cranford CS, Ho JY, Kalainov DM, Hartigan BJ. Carpal tunnel syndrome. J Am Acad Orthop Surg. 2007;15(9):537-48.

  5. Tosti R, Ilyas AM. Acute carpal tunnel syndrome. Orthop Clin North Am. 2012;43(4):459-65. 

  6. Peetrons PA, Derbali W. Carpal tunnel syndrome. Semin Musculoskelet Radiol. 2013;17(1):28-33.

  7. Tonga F, Bahadir S. The Factors Associated with Carpal Tunnel Syndrome Severity. Turk Neurosurg. 2022;32(3):392-7.

  8. Osiak K, Elnazir P, Walocha JA, Pasternak A. Carpal tunnel syndrome: state-of-the-art review. Folia Morphol (Warsz). 2021 Nov 16. doi: 10.5603/FM.a2021.0121. Epub ahead of print.

  9. Scanlon A, Maffei J. Carpal tunnel syndrome. J Neurosci Nurs. 2009;41(3):140-7. 

  10. Management of carpal tunnel syndrome. Drug Ther Bull. 2009;47(8):86-9. 

  11. Palmer KT. Carpal tunnel syndrome: the role of occupational factors. Best Pract Res Clin Rheumatol. 2011;25(1):15-29.

  12. Shannon H, Rizzolo D. Carpal tunnel syndrome: symptoms, diagnosis, and treatment options. JAAPA. 2012;25(9):22-6.

  13. Duckworth AD, Jenkins PJ, McEachan JE. Diagnosing carpal tunnel syndrome. J Hand Surg Am. 2014;39(7):1403-7.

  14. Zamborsky R, Kokavec M, Simko L, Bohac M. Carpal Tunnel Syndrome: Symptoms, Causes and Treatment Options. Literature Reviev. Ortop Traumatol Rehabil. 2017;19(1):1-8. 

  15. Ng AWH, Griffith JF, Tong CSL, Law EKC, Tse WL, Wong CWY, et al. MRI criteria for diagnosis and predicting severity of carpal tunnel syndrome. Skeletal Radiol. 2020;49(3):397-405.

  16. Alanazy MH. Clinical and electrophysiological evaluation of carpal tunnel syndrome: approach and pitfalls. Neurosciences (Riyadh). 2017;22(3):169-80. 

  17. Pugdahl K, Tankisi H, Fuglsang-Frederiksen A. Electrodiagnostic Testing of Entrapment Neuropathies: A Review of Existing Guidelines. J Clin Neurophysiol. 2020;37(4):299-305. 

  18. Sucher BM, Schreiber AL. Carpal tunnel syndrome diagnosis. Phys Med Rehabil Clin N Am. 2014;25(2):229-47.

  19. Werner RA, Andary M. Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve. 2011;44(4):597-607.

  20. Gervasio A, Stelitano C, Bollani P, Giardini A, Vanzetti E, Ferrari M. Carpal tunnel sonography. J Ultrasound. 2020;23(3):337-47.

  21. Chen YT, Williams L, Zak MJ, Fredericson M. Review of Ultrasonography in the Diagnosis of Carpal Tunnel Syndrome and a Proposed Scanning Protocol. J Ultrasound Med. 2016;35(11):2311-24. 

  22. Huisstede BM, Hoogvliet P, Franke TP, Randsdorp MS, Koes BW. Carpal Tunnel Syndrome: Effectiveness of Physical Therapy and Electrophysical Modalities. An Updated Systematic Review of Randomized Controlled Trials. Arch Phys Med Rehabil. 2018;99(8):1623-1634.e23.

  23. Zaralieva A, Georgiev GP, Karabinov V, Iliev A, Aleksiev A. Physical Therapy and Rehabilitation Approaches in Patients with Carpal Tunnel Syndrome. Cureus. 2020;12(3):e7171. 

  24. Kim JC, Jung SH, Lee SU, Lee SY. Effect of extracorporeal shockwave therapy on carpal tunnel syndrome: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2019;98(33):e16870. 

  25. Li W, Dong C, Wei H, Xiong Z, Zhang L, Zhou J, et al. Extracorporeal shock wave therapy versus local corticosteroid injection for the treatment of carpal tunnel syndrome: a meta-analysis. J Orthop Surg Res. 2020;15(1):556.

  26. Li ZJ, Wang Y, Zhang HF, Ma XL, Tian P, Huang Y. Effectiveness of low-level laser on carpal tunnel syndrome: A meta-analysis of previously reported randomized trials. Medicine (Baltimore). 2016;95(31):e4424.

  27. Burger M, Kriel R, Damon A, Abel A, Bansda A, Wakens M, e al. The effectiveness of low-level laser therapy on pain, self-reported hand function, and grip strength compared to placebo or "sham" treatment for adults with carpal tunnel syndrome: A systematic review. Physiother Theory Pract. 2017;33(3):184-97.

  28. Piazzini DB, Aprile I, Ferrara PE, Bertolini C, Tonali P, Maggi L, et al. A systematic review of conservative treatment of carpal tunnel syndrome. Clin Rehabil. 2007;21(4):299-314.

  29. Peris Moya A, Pérez Mármol JM, Khoury Martín EF, García Ríos MC. Ultrasound improves motor distal latency on patients with carpal tunnel syndrome: systematic review and meta-analysis. Eur J Phys Rehabil Med. 2022;58(2):206-17.

  30. Robertson VJ, Baker KG. A review of therapeutic ultrasound: effectiveness studies. Phys Ther. 2001;81(7):1339-50. 

  31. Page MJ, O'Connor D, Pitt V, Massy-Westropp N. Therapeutic ultrasound for carpal tunnel syndrome. Cochrane Database Syst Rev. 2013;2013(3):CD009601. 

Published
2022/10/19
Issue
Vol. 73 No. 3 (2022): Medicinski podmladak
Section
Mini pregledni članak