Median Nerve Compression & Carpel

Tunnel SyndromeJess Irvin & Kayla Jarrett

Case Study: Ursula 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

Anatomy & Symptoms of Median Nerve Compression

Signs and Symptoms• Loss of FM coordination

(“clumsiness”)• Tingling and radiating pain

in the hand and/or forearm

Assessment of Median Nerve Compression

Location Assessment/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

Results of Evaluation & Tx Plan

Conditions: Bilateral CTS due to repetitive stress from work Interventio

nPrecautions Contraindications

Strengthening Exercises

pain Pain, recent surgery, Lifting, Pulling, Grasping, or Pinching on hand with CTR until doctor has given the okay.

Nerve Gliding pain Fractures, Open Wounds, or If any of the poses go against physician orders such as excess flexion/extension after CTR surgery

Tendon Gliding

pain Same as above

Splinting Boney prominences, areas of diminished skin integrity, areas of sensation loss, fluctuating edema, do not compress the radial nerve

Open wounds, edema, signs of discoloration

Other Tx & Contributing Factors

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.

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http://www.eorthopod.com/content/median-nerve- compression-its-not-just-carpal-tunnel-syndrome

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