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A Multidisciplinary Approach Combining Physical Therapy and Osteopathic Medicine to Treat a Patient with Carpal Tunnel Syndrome

2003

A MULTIDISCIPLINARY APPROACH COMBINING PHYSICAL THERAPY AND OSTEOPATHIC MEDICINE TO TREAT A PATIENT WITH CARPAL TUNNEL SYNDROME

Carly Scheid*, Kirsten R. Buchanan

UNIQUE: Carpal tunnel syndrome (CTS) is a common upper extremity (UE) entrapment neuropathy that is characterized as an overuse syndrome and can be difficult to treat.^{1, 2} Contributing factors to CTS include: tendinitis/tendinosis of the wrist flexors and inflammation as a result of repetitive movement.^{1, 3, 4} Other contributing factors include pregnancy, poor posture, hypothyroidism, high body mass index, and female gender.^2-4 A multidisciplinary approach to clinical care has been found to be beneficial in treating patients with a variety of health conditions.^5-7 However, while other patient populations have benefitted from a multidisciplinary approach, CTS has not been extensively studied from this perspective.
PURPOSE: The purpose of this case report was to describe a multidisciplinary approach combining physical therapy (PT) and osteopathic medicine in the treatment of CTS.
FOUNDATION: Symptoms of CTS can range from mild tingling in the hands and fingers to incapacitating pain and weakness.^{1, 2} CTS is one of the most common injuries seen in occupational health industries, specifically in women with an incidence rate of 1.5 per 1000 compared to 0.5 per 1000 men.^{2, 4} Additionally, women who breast-feed, are pregnant, or taking hormone replacement therapy are more susceptible to CTS. ^4-7 Numerous disciplines have investigated the best interventions to treat CTS including physical therapy and osteopathic medicine.^8-10
Physical Therapy interventions often include postural training, ergonomic assessment, stretching and strengthening exercises, modalities, and hand splints.¹¹ Similarly, osteopathic research has also indicated the efficacy of steroid injections in symptom relief. ^{9, 12}
In many fields of medicine, there is evidence to suggest that collaboration among disciplines results in optimal patient outcomes.⁶ Tsakitzidis et al (2016) found that when elderly patients with complex comorbidities received comprehensive, multidisciplinary care, patients reported higher satisfaction and better outcomes.⁵ While individual studies indicate that both PT and osteopathic interventions work separately for CTS, no known research has investigated a multidisciplinary approach.
DESCRIPTION: The patient was a 32-year-old female diagnosed with CTS, who lived with her husband and 8-month-old child. At her initial PT evaluation, the patient presented with popping and locking at the wrist and tingling into the fingers. She was unable to participate in her normal roles at work and home due to difficulty gripping, cooking, typing, and caring for her child. Impairments consisted of flexibility, range of motion, strength, posture, and pain. The patient's other contributing factors included recent pregnancy, hormone replacement therapy, high body mass index, hypothyroidism, and a previous CTS episode. The patient's goals were to return to work restriction-free, cook without increased symptoms, and provide pain-free childcare.
The patient was seen for 45 minutes, three times weekly, for 28 sessions. Physical therapy interventions included joint mobilizations, manual stretching, myofascial release (MFR), an ergonomic work evaluation, mobility and strength exercises, hand splints, modalities, and patient education.^13-19 Three osteopathic treatment sessions, interspersed through her PT plan of care, included two separate steroid injections in her right carpal tunnel and one in her right subacromial bursa. Outcome measures at initial evaluation and discharge included grip and pinch strength measured by a dynamometer, the QuickDASH scale, and the numeric pain rating scale (NPRS).
OBSERVATIONS: Grip strength measured by a grip dynamometer with elbow flexed increased from 40 pounds at initial evaluation to 51 pounds at discharge on the right and from 42 pounds to 53 pounds on the left. Right pinch strength as measured by a pinch dynamometer increased from 12 pounds to 15 pounds, while left stayed the same at 13 pounds. The QuickDASH score decreased from 45.45% disability at initial evaluation to 27.27% level of disability at the time of discharge. Additionally, the patient's pain decreased from 6/10 to 0/10 as measured by the Numeric Pain Scale.
CONCLUSIONS: This case report supported the premise that a multidisciplinary approach that included PT and osteopathic interventions was beneficial for a patient with CTS. Future research should consider investigating a multidisciplinary approach in a larger population of patients with CTS.
FUNDING SOURCE: None
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KEYWORDS: carpal tunnel, multidisciplinary, physical therapy

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*First author