Carpal Tunnel Syndrome Physiotherapy Case Study

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KPJ HEALTHCARE UNIVERSITY COLLEGE OF NURSING AND HEALTH SCIENCES

DIPLOMA IN PHYSIOTHERAPY

CLINICAL POSTING AT KEDAH MEDICAL CENTRE

‘CARPAL TUNNEL SYNDROME’

NAME:Noor Syafiqah Izzati binti Suhairi
MATRIX NO.:10DPY0140
SEMESTER/COHORT:6/Cohort 9
LECTURER IN-CHARGE:Miss Nurshazana Akmal Binti Jamaludin

Contents

No.| Topic| Page|
1| Definition| 1|
2| Pathogenesis and pathophysiology| 1|
3| Causes| 2|
4| Symptoms| 3|
5| Diagnosis| 3|
6| Doctor’s management| 3|
7| Physiotherapy management| 4|
8| Patient Assessment| 5|
9| References| 12|

Definition

The median nerve, which controls movement and feeling in the palm-side of the hand, runs from the forearm to the hand through the carpal tunnel in the wrist. The bottom and sides of this tunnel are formed by bones, and the top of the tunnel is covered by strong band of connective tissue called a ligament.

Repetetive movement, or certain conditions such as pregnancy and arthritis, can cause swelling within the carpal tunnel. The swelling puts pressure on the median nerve and can cause numbness, tingling, or pain in the thumb or fingers. This is known as carpal tunnel syndrome.

(Eversmann, 1993)

Pathogenesis and Pathophysiology

* The pathogenesis and pathophysiology of carpal tunnel syndrome is predominantly attributable to nerve dysfunction secondary to chronic mechanical compression. * Histological abnormalities consist of paranodal myelin retraction with bulbous paranodal swellings, segmental demyelination, and variable degrees of axonal degeneration as well as remyelination and axonal regeneration. * There is also focal increase in endoneurial and perineural connective tissue and thickening of blood vessels. * The contribution of superimposed ischemia in causing some of these connective tissue changes and axonal degeneration is not well defined. * Nerves entrapped in the carpal tunnel are are more likely than normal nerves to become symptomatic with ischemia (Fullerton 1963). * Paresthesias reflect spontaneous activity in the damaged nerve induced by ischemia. * Wrist flexion and extension produce further increases and eventual neurologic dysfunction.

Causes

Carpal tunnel syndrome usually does not have one specific cause. Any action or condition that contributes to swelling within the carpal tunnel can be a factor.

Tasks associated with carpal tunnel syndrome often involve:

* Repetitive hand motions.
* Awkward hand positions.
* Strong gripping.
* Mechanical stress on the palm.
* Vibration.
Medical conditions associated with carpal tunnel syndrome include: * Athritis.
* Diabetes.
* Gout.
* Amyloidosis (the build up of abnormal proteins in the body’s organs). * Hypothyroidism (subnormal activity of the thyroid gland). * Tendon sheath tumors.
* Wrist fractures and dislocations.
* Wrist cysts.
In women, carpal tunnel syndrome can occur with:
* Pregnancy.
* Use of oral contraceptives.
* Menopause.
* Gynecological surgery.

Symptoms

The first sign of carpal tunnel syndrome is usually pain in one or both hands. This can happen during activity or in the middle of the night, and be severe enough to interrupt sleep. Other symptoms may include: * Tingling or pain in the thumb or fingers.

* Pain that moves from the palm or fingers to the arm.
* Weakness in the thumb and fingers, difficulty squeezing things. * Numbness in the fingers.
* Difficulty telling hot from cold with the fingers.
* Change in sweat functions of hand.

Diagnosis

* Patient’s descriptions of symptoms
* Electrodiagnostic tests
- measure nerve conduction through the hand.
* Physical exam
-...
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