[article] in Journal of Orthopaedic & Sports Physical Therapy > vol. 49, 5 (mai 2019) . - p. CPG1-CPG60 Titre : | Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome [Dossier] : Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Academy of Hand and Upper Extremity Physical Therapy and the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association | Type de document : | article de périodique | Auteurs : | Mia Erikson ; Marsha Lawrence ; Caroline Stegink-Jansen ; [et al.], Auteur | Année de publication : | 2019 | Article en page(s) : | p. CPG1-CPG60 | Langues : | Anglais (eng) | Descripteurs (mots clés) : | [Thésaurus HELB]:Paramédical:canal carpien [Thésaurus Mesh]Guide de bonnes pratiques [Thésaurus Mesh]Syndrome du canal carpien
| Résumé : | When examining a patient with suspected carpal tunnel syndrome (CTS), clinicians should use Semmes-Weinstein monofilament testing (SWMT), using the 2.83 or 3.22 monofilament as the threshold for normal light touch sensation and static 2-point discrimination on the middle finger to aid in determining the extent of nerve damage. In those with suspected moderate to severe CTS, clinicians should assess any radial finger using the 3.22 filament as the threshold for normal. Semmes-Weinstein monofilament testing should be repeated by the same provider. In those with suspected CTS, clinicians should use the Katz hand diagram, Phalen test, Tinel sign, and carpal compression test to determine the likelihood of CTS and interpret examination results in the context of all clinical exam findings.Clinicians should assess and document patient age (older than 45 years), whether shaking their hands relieves their symptoms, sensory loss in the thumb, the wrist ratio index (greater than 0.67), and scores from the Boston Carpal Tunnel Questionnairesymptom severity scale (CTQ-SSS) (greater than 1.9). The presence of more than 3 of these clinical findings has shown acceptable diagnostic accuracy. There is conflicting evidence on the diagnostic accuracy and clinical utility of the upper-limb neurodynamic tests, scratch-collapse test, and tests of vibration sense in the diagnosis of CTS, and therefore no recommendation can be made.
Examination – Outcome Measures: Activity Limitations/Self-Reported Measures
Clinicians should use the CTQ-SSS to assess symptoms and the Boston Carpal Tunnel Questionnaire functional scale (CTQ-FS) or the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire to assess function when examining patients with CTS. Clinicians should use the CTQ-SSS to assess change in those undergoing nonsurgical management.
Examination – Activity Limitations/Physical Performance Measures
Clinicians may use the Purdue Pegboard (PPB) or the Dellon- modified Moberg pick-up test (DMPUT) to quantify dexterity at the onset of treatment and compare scores with established norms. Clinicians should not use the PPB test, Jebsen- Taylor Hand Function Test, or the Nine-Hole Peg Test to assess clinical change following carpal tunnel release (CTR) surgery. Clinicians may use the DMPUT to assess change following CTR surgery.
Examination – Activity Limitations/Physical Impairment Measures
Strength Measures
Clinicians should not use lateral pinch strength as an outcome measure for patients with nonsurgically or surgically managed CTS.
Clinicians should not use grip strength when assessing short-term (less than 3 months) change in individuals following CTR surgery.
Clinicians may assess grip strength and 3-point or tip pinch strength in individuals presenting with signs and symptoms of CTS and compare scores with established norms.
There is conflicting evidence on the use of tip and 3-point pinch strength and abductor pollicis brevis muscle strength testing in individuals following CTR surgery.
Sensory and Provocative Measures
Clinicians should not use threshold or vibration testing to assess change in individuals with CTS undergoing nonsurgical management until more evidence becomes available. Clinicians may use the Phalen test to assess change in those with CTR surgery at long-term follow-ups.
There is conflicting evidence on the use of sensory measures, including 2-point discrimination and threshold testing, to assess change over time in patients with surgically managed CTS.
Interventions – Assistive Technology
Clinicians may educate their patients regarding the effects of mouse use on carpal tunnel pressure and assist patients in developing alternate strategies, including the use of arrow keys, touch screens, or alternating the mouse hand. Clinicians may recommend keyboards with reduced strike force for patients with CTS who report pain with keyboard use.
Interventions – Orthoses
Clinicians should recommend a neutral-positioned wrist orthosis worn at night for short-term symptom relief and functional improvement for individuals with CTS seeking nonsurgical management.
Clinicians may suggest adjusting wear time to include daytime, symptomatic, or full-time use when night-only use is ineffective at controlling symptoms in individuals with mild to moderate CTS. Clinicians may also add metacarpophalangeal joint immobilization or modify the wrist joint position for individuals with CTS who fail to experience relief. Clinicians may add patient education on pathology, risk identification, symptom self-management, and postures/activities that aggravate symptoms.
Clinicians should recommend an orthosis for women experiencing CTS during pregnancy and should provide a postpartum follow-up evaluation to examine the resolution of symptoms.
Interventions – Biophysical Agents
Clinicians may recommend a trial of superficial heat for short-term symptom relief for individuals with CTS.
Clinicians may recommend the application of microwave or shortwave diathermy for short-term pain and symptom relief for patients with mild to moderate idiopathic CTS.
Clinicians may offer a trial of interferential current for short-term pain symptom relief in adults without pacemakers with idiopathic, mild to moderate CTS. As with all electrical modalities, contraindications should be taken into consideration before choosing this intervention.
Clinicians should not use low-level laser therapy or other types of nonlaser light therapy for individuals with CTS.
Clinicians should not use thermal ultrasound in the treatment of patients with mild to moderate CTS.
There is conflicting evidence on the use of nonthermal ultrasound in the treatment of patients with mild to moderate CTS, and therefore no recommendation can be made.
Clinicians should not use iontophoresis in the management of mild to moderate CTS.
Clinicians may perform phonophoresis within nonsurgical management of patients with mild to moderate CTS for the treatment of clinical signs and symptoms.
Clinicians should not use or recommend the use of magnets in the intervention for individuals with CTS.
Interventions – Manual Therapy Techniques
Clinicians may perform manual therapy, directed at the cervical spine and upper extremity, for individuals with mild to moderate CTS in the short term.
There is conflicting evidence on the use of neurodynamic mobilizations in the management of mild to moderate CTS.
Interventions – Therapeutic Exercise
Clinicians may use a combined orthotic/stretching program in individuals with mild to moderate CTS who do not have thenar atrophy and have normal 2-point discrimination. Clinicians should monitor those undergoing treatment for clinically significant improvement | Permalink : | https://bibliotheque.helb-prigogine.be/opac_css/index.php?lvl=notice_display&id= |
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