Clin/tech- 3 Carpal Tunnel, Tos, Piriformis Syndrome

Front 1

What is Carpal Tunnel Syndrome?

Back 1

Compression injury of median N. (btwm carpal bones and flex retinaculum) due to inflamed tendons

Front 2

What is the presentation of Carpal Tunnel?

Back 2

- Initially: P. and numbness at night
- Later: decreased/lost sensation in lat 3 1/2 digits and adjacent palm of hand, dorsum hand= distal halves of same digits involved, paresis and atrophy of thumb intrinsic mm may follow, P. may radiate into forearm and occasionally to shoulder

Front 3

Indicators from Health History?

Back 3

- Numbness and tingling in thumb through radial half of ring finger
- P. or waking at night
- Clumsiness/weakness in hand
- Trouble grasping/holding things

Front 4

Prevalence from Carpal Tunnel?

Back 4

- Occupation require: working in cold environment, gripping of vibration tools (construction)
- Other population: pregnancy

Front 5

SOT for Carpal Tunnel: Phalen's Sign

Back 5

Test: Flexion of pt wrist and holds position for 1 min
+VE: tingling in thumb, index finger and middle and lat half of ring finger

Front 6

SOT for Carpal Tunnel: Reverse Phalen's Sign

Back 6

Test: Extends pt wrist and held for 1 min
+VE: tingling in thumb, index finger and middle and lat half of ring finger

Front 7

SOT for Carpal Tunnel: Tinel's Sign

Back 7

Test: examiner taps over carpal tunnel
+VE: tingling/paresthesia into thumb, index finger and middle and lat half of ring finger (median never distribution). Tingling/paresthesia must be felt distal to point of pressure for a +ve test

Front 8

What is the Tx for Carpal Tunnel?

Back 8

- Mild Case: 1 mo. rest, splinting, and anti-inflammatory medication (to reduce trauma and edema), followed by exercises designed to promote gliding of tendons in carpal tunnel (to improve blood flow), constitute sufficient intervention
- Severe Case: change to diff occupation, surgical release (sever transverse carpal lig may be necessary)

Front 9

What is the MT Tx for Mild Case?

Back 9

- Joint mobs
- Tx of compensatory structures (depending on ADL)
- General swedish massage- full arm

Front 10

What is the MT Tx for Severe Case?

Back 10

Treat:
- Compensatory structures: treating surrounding structures
- Scar work: mobilizing scar, increasing mobility of scar
- ROM: increasing ROM

Front 11

What is the MT Tx for Surgical Intervention of Carpal Tunnel?

Back 11

Carpal Tunnel Release:
- Frictions- scar tissues
- PNF stretching

Front 12

What is the Homecare/RemEx for Carpal Tunnel?

Back 12

W/out it: ccardinal rule is to ensure that you aren't aggravating condition
Looking at: stretching compensatory mm, grip strengthening, wrist strengthening

Front 13

What is Thoracic Outlet Syndrome?

Back 13

Compression on blood vessels or nerves as they pass through clavicle and upper ribs
-P. in neck and shoulder, numbness and tingling of fingers and weak grip

Front 14

What are the 4 areas of vulnerability to compressive forces?

Back 14

1. Superior thoracic outlet: brachial plexus passes over 1st rib
2. Scalene triangle: may be overlapping insertions of ant and mid scalenes onto 1st rib
3. Costoclavicular interval: space btwn 1st rib and clavicle where neurovascular bundle passes
4. Under coracoid process: where brachial plexus passes and is bordered ant by pec minor

Front 15

Indicators from Health History?

Back 15

- Changes in sensation, or temp in hand

Front 16

SOT TOS: Adson's Test

Back 16

- Location of compression: compression of neurovascular bundle btwn ant and mid scalene mm
- Test: Client's head EXT and ROT to side being tested. Palpate radial pulse while EXT and EXT ROT shoulder. Pt take deep breath and hold it while therapist continue to palpate pulse
- +ve: decrease/disappearance of radial pulse

Front 17

SOT TOS: Halstead's Maneuver

Back 17

- Location of compression: presence of cervical rib compressing the neurovascular bundle
- Test: client HYPEXT head and ROT AWAY from side being tested. Therapist palpates radial pulse as therapist exerts downward traction force on upper limb
- +ve: diminished/absent radial pulse

Front 18

SOT TOS: Costoclavicular Syndrome Test

Back 18

- Location of compression: entrapment of subclavian artery and brachial plexus btwn 1st rib and clavicle
- Test: therapist palpates radial pulse while depressing and retracting clients shoulder complex
- +ve: decrease/disappearance of radial pulse

Front 19

SOT TOS: Wright's Maneuver (aka Hyper AB Sundrome Test)

Back 19

- Location of compression: entrapment of subclavian vessels and brachial plexus beneath pec minor
- Test: client sit, therapist places clients arm in HYPER AB while palpating radial pulse
- +ve: decrease/disappearance of radial pulse

Front 20

SOT TOS: Allen's Test

Back 20

- Location of compression: compromise of neurovascular bundle by ant scalene
- Test: clients shoulder AB to 90 degrees and elbow FLX to 90 degrees. Therapist palpates radial pulse as they ask client to look away from side being tested
- +ve: radial pulse weakens or disappears when pt ROT head

Front 21

SOT TOS: Roose Test

Back 21

- Location of compression: assess for neural or vascular compromise in thoracic outlet
- Test: (chicken dance) client standing w/ both shoulder AB to 90 degrees and elbows FLX to 90 degrees, client opens and closes hands for 3 minutes
- +ve: pt can't maintain position, ischemic P., numbness or heaviness of arm

Front 22

Homecare/RemEx for TOS?

Back 22

- Stretching: increase space in thoracic outlet (scalenes and pectorals), kinesio tape
- Strengthen: stability ball (T's and Y's lifting), postural mm (rhomboids, traps)
- Joint mobs: shoulder, ribs, scapula, clavicle

Front 23

What is Piriformis Syndrome?

Back 23

Compression of sciatic N by piriformis mm

Front 24

What are the indications of Piriformis Syndrome?

Back 24

- P. and weakness w/ AB and lat rot of hip
- P. w/ passive med rot of ext hip
- Burning P. felt in sacral and/or gluteal region
- Med rot w/ flexion of hip recreates symp

Front 25

SOT for Piriformis Test 1

Back 25

Test: pt in side lying position w/ test leg on top. Pt flexes hip to 60 degrees w/ knee flexed. Examiner stabilizes hip w/ one hand and applies downward pressure to knee
+VE: piriformis mm pinching sciatic N., P in buttock and sciatica may be experienced

Front 26

SOT for Piriformis Test 2

Back 26

Test: resisted lat rot w/ mm on stretch *in hip med rot)
+ve: reproduction of sciatic symp