Evidence-based Occupational Therapy Interventions for Carpal Tunnel Syndrome

Presented By: Jennifer Bohnert, OTSVision in Action Conference

January 23, 2015

Carpal Tunnel Syndrome (CTS) What is CTS? Affects 10

million people annually

Cost: $13 billion per year

Conservative vs. surgical

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Focused Question

Which conservative occupational therapy intervention yields the best functional outcomes for the client

with carpal tunnel syndrome?

Evidence for Splinting

Disagreements on use Hall et. al (2013) -

Neutral wrist splint worn full-time

Warner et. al. (2005) - Neutral wrist splint worn at night

Porrata (2007)- C-TRAC device

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But is Splinting Alone Enough? Stretches

Tendon and Nerve gliding ▪ Horng et. al. (2011)

Lumbrical Stretches▪ Baker et. al. (2012)

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Retrieved from: Baker et. al. (2012)

What about modalities?

Splinting, exercises, ultrasound Baysal et al. (2006)

Splinting with ultrasound vs. phonophoresis Yildiz et al. (2011)

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Clinical Implications

Conservative treatment is effective Splinting Fieldwork experience More research needed

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Questions?

Contact information:Jennifer Bohnert, OTSjenniferabohnert@gmail.com

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References

Baker, N. A., Moehling, K. K., Rubinstein, E. N., Wollstein, R., Gustafson, N. P., & Barat, M. (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, 93, 1-10. doi:10.1016/j.apmr.2011.08.013

Baysal, O., Altay, Z., Ozcan, C., Ertem, K., Yologlu, S., & Kayhan, A. (2006). Comparison of three conservative treatment protocols in carpal tunnel syndrome. International Journal of Clinical Practice, 60, 820-828. doi: 10.1111/j.1368-5031.2006.00867x

Hall, B., Lee, H. C., Fitzgerald, H., Bryne, B., Barton, A., & Lee, A. H. (2013). Investigating the effectiveness of full-time wrist splinting and education in the treatment of carpal tunnel syndrome: A randomized controlled trial. American Journal of Occupational Therapy, 67, 448-459. doi: 10.5014/ajot.2013.006031

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, 435-442. doi:10.1097/PHM/0b013e318214eaaf

Porrata, H., Porrata, A., & Sosner, J. (2007). New carpal ligament traction device for the treatment of carpal tunnel syndrome unresponsive to conservative treatment. Journal of Hand Therapy, 20, 20-8. doi:10.1197/j.jht.2006.10.001

Warner, R., Franzblau, A., & Gell, N. (2005). Randomized controlled trial of nocturnal splinting for active workers with symptoms of carpal tunnel syndrome. Archives Physical Medicine and Rehabilitation, 86, 1-7. doi: 10.1016/j.apmr.2004.05.013

Yildiz, N., Atalay, N. S., Gungen, G. O., Sanal, E., Akkaya, N., & Topuz, O. (2011). Comparison of ultrasound and ketoprofen phonophoresis in the treatment of carpal tunnel syndrome. Journal of Back and Musculoskeletal Rehabilitation, 24, 39-47. doi.10.3233/BMR-2011-0273