1. Jess Irvin & Kayla Jarrett

2.  44 y/o, African American, Female  Hairdresser/stylist, Heavy workload  2 weeks s/p CTR on the R UE  Referral to Outpatient OT to regain function and strength following CTR and to address similar (CTS) symptoms in the L UE  Client’s Goal: Return to work at full capacity in 2 weeks  44 y/o, African American, Female  Hairdresser/stylist, Heavy workload  2 weeks s/p CTR on the R UE  Referral to Outpatient OT to regain function and strength following CTR and to address similar (CTS) symptoms in the L UE  Client’s Goal: Return to work at full capacity in 2 weeks

3. Signs and Symptoms Loss of FM coordination (“clumsiness”) Tingling and radiating pain in the hand and/or forearm

4. LocationAssessment/Provocative Test All UE peripheral nerve injuries (unless where contraindicated) Semmes-Weinstein Two-Point Discrimination Pain scale MMT, ROM, FM coordination Wrist (Carpal Tunnel) Tinel’s Test Phalen’s Test * Grip & Pinch strength * Elbow/Forearm (anterior interosseous nerve syndrome, pronator syndrome) Tinel’s Test Long Finger Flexion Shoulder/Neck Tinel’s Test * CAUTION: Following CTR surgery: the Phalen’s Test is contraindicated if the client has not been cleared for excessive extension/flexion of the wrist. Grip and Pinch Strength & MMT are contraindicated if the client has not been cleared for resistance activities

5.  Conditions: Bilateral CTS due to repetitive stress from work InterventionPrecautionsContraindications Strengthening Exercises painPain, recent surgery, Lifting, Pulling, Grasping, or Pinching on hand with CTR until doctor has given the okay. Nerve GlidingpainFractures, Open Wounds, or If any of the poses go against physician orders such as excess flexion/extension after CTR surgery Tendon GlidingpainSame as above SplintingBoney prominences, areas of diminished skin integrity, areas of sensation loss, fluctuating edema, do not compress the radial nerve Open wounds, edema, signs of discoloration

6.  Patient Education Smoking cessation Management of Workload/rest Adherence to the splinting and HEP schedule Next steps/other Tx options Avoiding/limiting vulnerable positioning of the wrist during daily activities  Flex/ext of wrist, etc.

7. Al-Dabbagh, K., & Mohamad, S. (2013). Sensitivity and specificity of Phalen’s Test and Tinel’s Test in patients with carpal tunnel syndrome. Diyala Journal of Medicine, 5(1), 1-14. Retrieved September 9, 2014, from the Google Scholar database. Brininger, T. L., Rogers, J. C., Holm, M.B., Baker, N. A., Li, Z., & Goltz, R. J. (2007). Efficacy of a fabricated splint and tendon and nerve gliding exercises for the treatment of carpal tunnel syndroe: A randomized contontrolled trial. Archivs of Physical Medicine and Rehabilitation, 88(11), 1429-1435 Cooper, C. (2007). Fundamentals of hand therapy: clinical reasoning and treatment guidelines for common diagnoses of the upper extremity. St. Louis: Mosby Elsevier. 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. American Journal of Physical Medicine & Rehabilitation, 90(6), 435-442. Kim, P., Lee, H., Kim, T., & Jeon, I. (2014). Current approaches for carpal tunnel syndrome. Clinics in Orthopedic Surgery, 6(3), 253-257. Retrieved September 9, 2014, from the pubmed database. Median Nerve Compression: It's Not Just Carpal Tunnel Syndrome. (n.d.). eOrthopod. Retrieved September 9, 2014, from http://www.eorthopod.com/content/median- nerve- compression-its-not-just-carpal-tunnel-syndrome Michlovitz, S. L. (2004). Conservative interventions for carpal tunnel syndrome. Journal of Orthopaedic & Sports Physical Therapy, 34, 589-600. Retrieved September 9, 2014, from http://rosephysicaltherapy.com/pdfs/SuggestedReading/article%20wrist%20hand%20CTS%20mgt%20October2004%20JOSPT%20Michlovitz.pdf Olehnik, W., Manske, P. R., & Szerzinski, J. (1994). Median nerve compression in the proximal forearm. The Journal of Hand Surgery, 19(1), 121-126. Retrieved September 6, 2014, from the Science Direct database. Rarely Seen Nerve Compression Syndromes of the Upper Extremity. (n.d.). TurkHand Society TEECD RSS. Retrieved September 14, 2014, from http://www.turkhandsociety.org/english/?p=121 Rozmaryn, L. M., Dovelle, S., Rothman, E. R., Gorman, K., Olvey, K. M., & Bartko, J. J. (1998). Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome. Journal of Hand Therapy, 11(3), 171-179. Urbano, F. (2000). Tinel;s Sign and Phalen’s Maneuver: Physical signs of carpal tunnel syndrome. Hospital Physican, 36, 39-44. Retrieved September 9, 2014, from http://www.turner-white.com/pdf/hp_jul00_tinel.pd