1. Effective Intervention Strategies to Promote Occupational Performance Among Individuals with Carpal Tunnel Syndrome
Madalyn Payne, OTS

2. Identification of Topic
Level II Fieldwork
Ireland Army Community Hospital, Fort Knox, KY
Carpal Tunnel Syndrome in today’s society
My mother

3. Carpal Tunnel Syndrome
Compression of median nerve
Numbness, tingling, pain
Sensory nerve distribution
Motor distribution
Most common nerve entrapment

4. How is it diagnosed? Subjective statements Provocative tests
Tinels
Phalens
EMG/Nerve conduction study

5. Occupational Performance!
Why do we care?
Occupational Performance!
CTS can greatly effect a person’s occupational performance. The numbness, tingling, and pain associated with CTS can cause a decrease in occupational performance.
** anecdote: Patient that I treated while at clinicals waited too long to seek treatment for CTS and she was starting to drop items that she was holding and did not have any control over her grip.

6. Evidence-Based Treatments
Tendon and nerve gliding exercises

7. Evidence-Based Treatments
Massage techniques
Ischemic compression
CTS targeted
Soft tissue mobilization
Graston Instrument
Deep tissue massage to release trigger points to help increase blood flow to increase healing among the proximal UE where median nerve can be entrapped

8. Evidence-Based Treatments
Splinting combined with lumbrical stretches

9. Evidence-Based Treatments
Full time splinting and formal education
Ketoprofen phonophoresis combined with splinting
Wrist cock-up splint; formal education included classes on self-management to teach causes of CTS and ways to prevent such as decreasing repetitive movements
Using ultrasound with steroid medication to decrease inflammation to decrease compression of median nerve

10. Clinical Implications for OT
Conservative treatment options to prevent/prolong surgery
All have been shown to decrease signs and symptoms
Treatment post-surgery
Scar management
ROM
Occupation-based treatments
Need is only going to increase
Getting back to function!!

11. References
Burke, J., Buchberger, D. J., Carey-Loghmani, M. T., Doughtery, P. E., Greco, D., & Dishman, D. (2007). A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. Journal of Manipulative and Physiological Therapeutics, 30(1), doi:
Hains, G., Descarreaux, M., Lamy, A., & Hains, F. (2010). A randomized controlled (intervention) trial of ischemic compression therapy for chronic carpal tunnel syndrome. Journal Of The Canadian Chiropractic Association, 54(3),
Horng, Y., Hsieh, S., Tu, Y., Lin, M., Horng, Y., & Wang, J. (2011). The Comparative Effectiveness of Tendon and Nerve Gliding Exercises in Patients with Carpal Tunnel Syndrome: A Randomized Trial. American Journal Of Physical Medicine & Rehabilitation, 90(6), doi: /PHM.0b013e318214eaaf
Moraska, A., Chandler, C., Edmiston-Schaetzel, A., Franklin, G., Calenda, E. L., & Enebo, B. (2008). Comparison of a Targeted and General Massage Protocol on Strength, Function, and Symptoms Associated with Carpal Tunnel Syndrome: A Randomized Pilot Study. Journal Of Alternative & Complementary Medicine, 14(3), doi: /acm
Nancy A. Baker, Krissy K. Moehling, Elaine N. Rubinstein, Ronit Wollstein, Norman P. Gustafson, Mark Baratz, (2012). The Comparative Effectiveness of Combined Lumbrical Muscle Splints and Stretches on Symptoms and Function in Carpal Tunnel Syndrome, Archives of Physical Medicine and Rehabilitation, Volume 93, Issue 1, January 2012, Pages 1-10, ISSN ,

12. Questions Any questions/comments about CTS research?
Other comments/suggestions…

13. Madalyn Payne, OTS mpayne@spalding.edu
Contact Information
Madalyn Payne, OTS