Carpal tunnel syndrome within the context of functional disorders of the musculoskeletal system

Czech version

Authors: R. Poděbradská ^1,2; L. Máchová ^2,3
Authors‘ workplace: Rehabilitace Lipová-lázně, REHEX – EDU, v. o. s., Horní Lipová ¹; Katedra podpory zdraví, FSpS MU Brno ²; Rehaspiro Praha ³
Published in: Cesk Slov Neurol N 2018; 81(2): 174-179
Category: Review Article
doi: https://doi.org/10.14735/amcsnn2018174

Overview

Carpal tunnel syndrome summarizes a set of signs manifesting tunnel hypertension in the carpal tunnel. The cause of tunnel hypertension is usually multifactorial, and it may include both structural and functional etiology. While the structural causes are well described, functional disorders of the musculoskeletal system, manifesting themselves in the area of the wrist as a carpal tunnel syndrome, are often neglected. Carpal tunnel syndrome is often resolved via surgical cutting of the ligamentum carpi transversum. Such intervention does, on one hand, bring about the regress of clinical problems in the area of the wrist, but it does not necessarily resolve the functional segment of the carpal tunnel syndrome etiology. The functional disorder of the musculoskeletal system may then become generalized, and it may eventually manifest itself in another part of the musculoskeletal system. Complex therapy of carpal tunnel syndrome should therefore, in indicated cases, also include a complex kinesiology analysis, which is a part of the examination by a physiotherapist, to assess the functional segment of the carpal tunnel syndrome etiology, therefore leading not only to the elimination of the clinical expression of the disorder in the area of the wrist, but also to the elimination of the cause of the disorder in the musculoskeletal system as a whole. Physiotherapy is suitable both in patients indicated for surgery and in post-surgical care with respect to a complex solution of this disease. The article brings a clear summary of the functional etiology of musculoskeletal system disorders and different options of physiotherapy in carpal tunnel syndrome.

Key words:
carpal tunnel syndrome – functional disorders of the musculoskeletal system – rehabilitation – complex kinesiology analysis

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Sources

1. Vaverka M. Karpální tunel a neurochirurg – zkušenosti po 2 200 operacích. Cesk Slov Neurol N 2012; 75/ 108(1): 44– 50.

2. Smrčka M, Vybíhal V, Němec M. Syndrom karpálního tunelu. Neurol praxi 2007; 8(4): 243– 246.

3. Fernandez-de-las Penas C, Cleland J, Palacios-Cena M et al. Effectiveness of manual therapy versus surgery in pain processing due to carpal tunnel syndrome: a randomized clinical trial. Eur J Pain, 2017; 21(7): 1266– 1276. doi: 10.1002/ ejp.1026.

4. Minks E, Minksová A, Brhel P et al. Profesionální syndrom karpálního tunelu. Neurol praxi 2014; 15(5): 234– 239.

5. Vodvářka T. Úžinové syndromy. Interní Med 2005; 7(2): 74– 80.

6. Poděbradská R. Úžinové syndromy – syndrom karpálního tunelu: účinky fyzioterapie. Diplomová práce. Olomouc: Univerzita Palackého v Olomouci, Fakulta tělesné kultury, Katedra fyzioterapie 2006. Dostupné z URL: https:/ / theses.cz/ id/ ozl4lb/ 19847-372444188.pdf?lang=cs; furl=%2Fid%2Fozl4lb%2F.

7. Poděbradský J, Poděbradská R. Fyzikální terapie – manuál a algoritmy. Praha: Grada Publishing a.s. 2009.

8. Lewit K. Manipulační léčba. 4. vyd. Leipzig: J.A. Barth Verlag 1996.

9. Travell JG, Simons DG. Myofascial pain and dysfunction The trigger point manual. 2nd ed. New York: Lippincott Williams & Wilkins 1999.

10. Janda V. Ke vztahům mezi strukturálními a funkčními změnami pohybového systému. Rehabil Fyz Lék 1999; 1: 6– 8.

11. Kolář P. Systematizace svalových dysbalancí z pohledu vývojové kineziologie. Rehabil Fyz Lék 2001; 4: 152– 164.

12. Kolář P et al. Rehabilitace v klinické praxi. Praha: Galén 2009: 58.

13. Ettema AM, Zhao C, Amadio PC et al. Gliding characteristics of flexor tendon and tenosynovium in carpal tunnel syndrome: a pilot study. Clin Anat 2007; 20(3): 292– 299.

14. Erel E, Dilley A, Greening J et al. Longitudinal sliding of the median nerve in patients with carpal tunnel syndrome. Journal Hand Surg 2003; 28(5): 439– 443.

15. Wahab KW, Sanya EO, Adebayo PB et al. Carpal tunnel syndrome and other entrapment neuropathies. Oman Med J 2017; 32(6): 449– 454. doi: 10.5001/ omj.2017.87.

16. Gelbreman RH, Hergenroede P, Hargens A. The carpal tunel syndrom: a study of capal canal pressures. J Bone Joint Surg Am 1981; 63(3): 380– 383.

17. Wolny T, Saulicz E, Linek P et al. Two-point discrimination and kinesthetic sense disorders in productive age individuals with carpal tunnel syndrome. J Occup Health 2016; 58(3): 289– 296. doi: 10.1539/ joh.15-0108-OA.

18. Katz JN, Simmons BP. Clinical practice. Carpal tunnel syndrome. N Engl J Med 2002; 346(23): 1807– 1812. doi: 10.1056/ NEJMcp013018.

19. Kadaňka Z, Dufek J, Hromada J. Standard elektrofyziologického vyšetření syndromu karpálního tunelu pro potřeby hlášení choroby z povolání. Česká neurologická společnost 2005. Dostupné z URL: http:/ / www.czech-neuro.cz/ pro-odborniky/ doporucene-postupy/ doporuceni-pro-prakticke-lekare/ sy-karpalniho-tunelu/ .

20. Burk DT, Burke NM, Steward GW et al. Splinting for carpal tunnel syndrome: a comparison of night-only verus full-time wear instructions. Arch Phys Med Rehabil 1994; 75(11): 1241– 1244.

21. Kanta M, Ehler E, Kremláček J et al. Efekt endoskopické a klasické operace pro syndrom karpálního tunelu. Cesk Slov Neurol N 2008; 71/ 104(2): 173– 179.

22. Horng YS, Hsieh SF, Lin MC et al. The comparative effectiveness of tendon and nerve gliding exercises in patients with carpal tunnel syndrome: a randomized trial. Am J Phys Med Rehabil 2011; 90(6): 435– 442. doi: 10.1097/ PHM.0b013e318214eaaf.

23. Mayer M, Smékal D. Syndromy bolestivého a dysfunkčního ramene: role krátkých depresorů hlavice humeru. Rehabil Fyz Lék 2005; 2: 68– 71.

24. Hermachová H. O fenoménu bariéry. Rehabil Fyz Lék 1996; 2: 81– 85

25. Lewit K, Olšanská Š. Klinický význam aktivních jizev. Rehabil Fyz Lék 2003; 4: 129– 132.

26. Tal-Akabi A, Rushton A. An investigation to compare the effectiveness of carpal bone mobilisation and neurodynamic mobilisation as methods of treatment for carpal tunnel syndrome. Man Ther 2000; 5(4): 214– 222.

27. Wolny T, Saulicz E, Linek P et al. Effect of manual therapy and neurodynamic techniques vs ultrasound and laser on 2PD in patients with CTS: a randomized controlled trial. J Hand Ther 2016; 29(3): 235– 245. doi: 10.1016/ j.jht.2016.03.006.

28. Rozmaryn L, Dovelle S, Rothman E et al. Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome. J Hand Ther 1998; 11(3): 171– 179.

29. Oskouei AE, Talebi GA, Shakouri SK et al. Effects of neuromobilization maneuver on clinical and electrophysiological measures of patients with carpal tunnel syndrome. J Phys Ther Sci 2014; 26(7): 1017– 1022. doi: 10.1589/ jpts.26.1017.

30. Bardak AN, Alp M, Erhan B et al. Evaluation of the clinical efficacy of conservative treatment in the management of carpal tunnel syndrome. Adv Ther 2009; 26(1): 107– 116. doi: 10.1007/ s12325-008-0134-7.

31. Goyal M, Mehta SK, Rana N et al. Motor nerve conduction velocity and function in carpal tunnel syndrome following neural mobilization: a randomized clinical trial. Int J Health Allied Sci 2016; 5(2): 104– 110. doi: 10.4103/ 2278-344X.180434.

32. Kolář P, Lewit K. Význam hlubokého stabilizačního systému v rámci vertebrogenních obtíží. Neurol Praxi 2005; 5: 270– 275.

33. Rychlý Z. Je syndrom karpálního tunelu diagnostickým a terapeutickým problémem? Sanquis 2002; 18: 20. Dostupné z URL: http:/ / www.sanquis.cz/ index1.php?linkID=art808.

34. Karolyi M, Komenda M, Janoušová R et al. Finding overlapping termis in medical and health care curriculum using test mining metrods: rehabilitation representation – a proof of concept. Mefanet J 2016; 4(2): 71– 77.