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Carpal tunnel syndrome - therapy options by influencing neurophysiology motion from the root joint
ŠUBERT, Daniel
The carpal tunnel syndrome (CTS) is the most common nerve compression syndrome of the upper limb. CTS is caused by repeated and long-term owerloading specific muscles group with successive compression of medianus nerve located in the wrist area also known as carpal tunnel. The lower part consists of 8 wrist bones covered by ligamentum transversum carpi. The tunnel makes a passage for other structures such as vessels and tendons, all of which being swelled can cause the CTS. CTS is more prevalent among females than among males with ratio 4 to 1. The number of patients suffering from the syndrome is growing higher even with advanced medical science and improved care for patients (Bitnar aj., 2009; Ehler, 2005; Mlčoch, 2008). CTS can affect anyone and the chance to suffer from this condition is around 10% for each individual (Mrzena 2006). The world wide patients' number increase is 0.1% (Katna 2006) and the net prevalence among population is within 2.7 - 3% (Mlčoch, 2008). In the USA, around 260,000 patients indicated with the CTS are operated. The compression of the nerve causes increasing pain and paresthesia. The first symptoms are recorded during night usually passing away with stroking of the hand and hand exercises. During later stages of CTS, the patients suffer from the pain even during day. After being examined by a neurologist, the patients are recommended to undergo a chirurgical treatment which is based on cutting of the ligamentum transversum carpi. The good recovery is ensured by immediate rehabilitation. One year after the chirurgical treatment, the patients are expected to regain full hand abilities. Contrary to the expectations, one patient out of four is not able to regain these abilities. A question arises, are the contemporary exercises of limbs upper acra, which are mainly used for rehabilitation of the patients, effective enough? Is it possible to incorporate these exercises into more complex recovery, implement knowledge of the science of neurophysiology and focus the exercises on the root joint to develop more effective recovery? This thesis integrates theory and empirical findings related with the CTS. The general literature part is focused on relevant anatomy, kinesiology, functional ontogenetic of the upper limb, ways to diagnose and therapy of CTS. The experimental sections of the thesis intents to develop and apply recovery treatment concentrated on the neurophysiology of managing movements from root joint and incorporate these treatments into the standard CTS recovery exercises. Furthermore, a short after CTS operation recovery program will be created and conducted. A set of exercises was developed to activation and strengthening of the glenohumeral joint so the effects would be made means of reflexes path to the acrum and also to the more distant stages of stabilizing system. Developed exercises were applied on two probands diagnosed with CTS. Probands participated on six sessions, during which they were treated with manual therapy of the wrist area and hand. Moreover, probands were informed and instructed how to conduct specific exercises of the glenohumeral joint. Afterwards, set of exercises were performed by probands at least once a week with duration of five to ten minutes. A part longer sessions, were devoted to supervision and correction of exercise program to increase effectively of the treatment. The kinesiological analysis was performed on the probands in the beginning and also in the end. The visual analog scale was utilized as subjective evaluation of therapy effectives. Objective evaluation was measured by staple test, goniometric test and grab test by Novak. The both of probands were fully recovered. Disappearance of the pain and improvement of general motion ability by operated limb were observed. Based on subjective as well objective test, the success of the therapy was proven.
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