KINESIO TAPE VERSUS ULTRASONIC IN THE TREATMENT OF CARPAL TUNNEL SYNDROME DURING PREGNANCY

Transcription

1 KINESIO TAPE VERSUS ULTRASONIC IN THE TREATMENT OF CARPAL TUNNEL SYNDROME DURING PREGNANCY By ASMAA MOHAMED AHMED MOHAMED B.Sc. in Physical Therapy, Thesis Submitted in Partial Fulfillment for Requirements of Master Degree of Physical Therapy, Department of Gynecology and Obstetrics, Faculty of Physical Therapy Supervisors Prof. Dr. Soheir Mahmoud ELKosery Assistant Professor of Physical Therapy for Gynecology and Obstetrics Faculty of Physical Therapy Cairo University Prof. Dr. Adel Farouk EL Begawy Professor of Gynecology and Obstetrics Faculty of Medicine Cairo University Dr. Fayiz Farouk Ibrahim Lecturer of Physical Therapy For Gynecology and Obstetrics Faculty of Physical Therapy Cairo University Faculty of Physical Therapy Cairo University

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3 Acknowledgment First of all and above all, I would like to thank Allah for giving me the strength and ability to conduct this work as a part of his generous help through our life. I am deeply indebted to Prof. Dr. Soheir Mahmoud EL Kosery, Assistant Professor of Physical Therapy for Gynecology and Obstetrics, Faculty of Physical Therapy, Cairo University for her continuous support, valuable supervision and encouragement. Words fail to express my gratitude, respect and appreciation to Prof. Dr. Adel Farouk EL Begawy, Professor of Gynecology and Obstetrics, Faculty of Medicine, Cairo University for his kind help, constant encouragement, real supervision and advices to accomplish this work. Whatever I wrote I will not be able to thank Dr. Fayiz Farouk Ibrahim, Lecturer of Physical Therapy for Gynecology and Obstetrics, Faculty of Physical Therapy, Cairo University as much as he disserves. He gave me valuable supervision and actual support for even starting this work. Finally I would like to thank all the physicians and stuff of El Khazendara General Hospital for their sincere support and help to accomplish the study at the hospital. I can not forget to thank all the patients who participated in this study for their great co-operation during the whole study. i

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5 KINESIO TAPE VERSUS ULTRASONIC IN THE TREATMENT OF CARPAL TUNNEL SYNDROME DURING PREGNANCY/ Asmaa Mohamed Ahmed, Supervisors: Prof. Dr.Soheir Mahmoud EL Kosery, Assistant Professor of Physical Therapy for Gynecology and Obstetrics, Faculty of Physical Therapy, Cairo University. Prof. Dr. Adel Farouk EL Begawy, Professor of Gynecology and Obstetrics, Faculty of Medicine, Cairo University. Dr. Fayiz Farouk Ibrahim, Lecturer of Physical Therapy for Gynecology and Obstetrics, Faculty of Physical Therapy, Cairo University, (Master Thesis about 87 pages, 2012). Abstract This study was designed to assess the effect of Kinesio tape versus ultrasonic on the treatment of carpal tunnel syndrome during pregnancy. Thirty primigravidae females at third trimester of pregnancy with positive electro diagnostic findings (MMDL >4.2 ms) participated in this study, their ages ranged between 20 to 35 years (27.53±4.47). They were divided randomly into two equal groups. Group (A) received kinesio tape application on the affected wrist for 3 days, then day off and then another three days each week for 4 weeks, while, Group (B) received a program of 12 sessions of pulsed ultrasound, 3 sessions per week for 15 minute per session. The treatment program continued for 4 weeks. Boston carpal tunnel questionnaire and median motor distal latency were performed before and after the treatment program for all patients of the two groups. The obtained results showed a highly statistically significant (P< ) improvement in both groups (A&B) concerning Boston carpal tunnel questionnaire and median motor distal latency. The improvement was highly significant (P< ) in group (A) when compared with group (B). Accordingly, it could be concluded that the use of therapeutic ultrasound or kinesio tape for carpal tunnel syndrome during pregnancy appeared to be effective. Yet, the kinesio tape was found to be more superior in comparing with therapeutic ultrasound for carpal tunnel syndrome management during pregnancy. Keywords: Kinesio tape, ultrasonic, carpal tunnel syndrome, pregnancy. ii

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7 LIST OF CONTENTS Contents Acknowledgement... List of tables... List of Figures... List of Abbreviations... Chapter (1): Introduction... Chapter (2): Literature review... Carpal Tunnel Syndrome... -What is The Carpal tunnel?... -Definition of Carpal tunnel syndrome... -Anatomy and Pathophysiologly... -Etiology... -Work and Carpal tunnel syndrome... -Carpal tunnel syndrome and other diseases... -Assessment... -The special tests for CTS diagnosis... -Boston CT questionnaire (BCTQ)... Pregnancy... -Definition... -Maternal Physiological changes in pregnancy... -Hormonal... -Cardiovascular... -Musculoskeletal... -Physical... -Metabolic... -Causes of CTS during pregnancy... -Frequency, severity and prevalence of CTS... -Management of CTS during pregnancy... Therapeutic Ultrasound... -History... -Definition... -Effects of ultrasonic on tissues... -Biophysical effect... -Thermal effect... -Non thermal effect... -Mechanical effect... -Indication of ultrasonic... Page iii

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9 -Contraindication... -Effect of ultrasonic treatment on CTS... Kinesio Tape... -History... -Definition... -The basis rationale and characteristic of kinesio tape. -Physiological effect of kinesio tape application... -Skin function... -Circulatory and /or lymph... -Fascia... -Muscle... -Joint... -Kinesio tape techniques... -Application's principles of Kinesio taping... -Uses of kinesio tape... -Taping precautions and contraindications... Chapter (III): Subjects, instruments and methods... Chapter (IV): Analysis of results... Chapter (V): Discussion... Chapter (VI): Summary, conclusion and recommendations... -Summary... - Conclusion... - Recommendations... References... Appendix... Arabic summary iv

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11 LIST OF TABLES Tab No Title of table Page 1 Physical characteristics of patients in both groups 48 (A&B) Mean values of patients' symptom severity scale (SSS) 50 pre and post treatment of group (A)... 3 Mean values of patients' symptom severity scale (SSS) 50 pre and post treatment of group (B) Mean values of patients' symptom severity scale (SSS) 51 pre and post treatment for both groups (A&B)... 5 Mean values of patients' functional status scale (FSS) 54 pre and post treatment of group (A) Mean values of patients' functional status scale (FSS) 54 pre and post treatment of group (B) Mean values of patients' functional status scale (FSS) 55 pre and post treatment for both groups (A&B)... 8 Mean values of patients' median nerve motor distal 58 latency pre and post treatment of group (A)... 9 Mean values of patients' median nerve motor distal 58 latency pre and post treatment of group (B) Mean values of median nerve motor distal latency pre and post treatment for both groups (A&B) v

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13 LIST OF FIGURES Fig No Title of figures Page 1 Cross section across wrist anatomy of the human Body Ultrasound waveform with compression and 23 rarefactions... 3 Ultrasound application on the palmar surface Principles of Kinesio taping in Application Computerized electromyography Weight and height scale 38 7 Kinesio tape Ultrasound instrument Application of ultrasonic therapy for Carpal tunnel 44 syndrome (CTS) Steps of kinesio tape application for Carpal tunnel 45 syndrome (CTS) Mean values of patients' ages, weights, heights and 48 BMI for both groups (A&B) Mean values of patients' symptom severity scale (SSS) 51 pre and post treatment of group (A) Mean values of patients' symptom severity scale (SSS) 52 pre and post treatment of group (B) Mean values of patients' symptoms severity scale 52 (SSS) pre and post treatment of both groups (A& B) 15 Mean values of patients' functional status scale (FSS) 55 pre and post treatment of group (A) Mean values of patients' functional status scale (FSS) 56 pre and post treatment of group (B) Mean values of patients' functional status scale (FSS) 56 pre and post treatment of both groups (A& B) Mean values of patients' median nerve motor distal 59 latency pre and post treatment of group (A) Mean values of patients' median nerve motor distal 60 latency pre and post treatment of group (B) Mean values of patients' median nerve motor distal latency pre and post treatment of both groups (A &B).. 60 vi

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15 LIST OF ABBREVIATIONS APB : Abductor pollicis brevis. BCTQ : Boston carpal tunnel questionnaire. β-hcg : β -human chorionic gonadotropin. BMI : Body mass index. CTS : Carpal tunnel syndrome. DF : Degree of freedom. EMG : Electromyography. EP : Evoked potential. FCU : Flexor carpi ulnaris. FDP : Flexor digitorum profundus. FDS : Flexor digitorum superficialis. FPL : Flexor pollicis longus. FSS : Functional status scale. GTO : Golgi tendon organ. Kg : Kilogram. HPL : Human placental lactogen. HS : Highly significant. H/WK : Hours per week. Hz : Hertz. Kt : Kinesio tape. LNMP : Last normal menstrual period LCD : Liquid crystal display. MHZ : Mega hertz. ML : Milliliter. MMDL : Median motor distal latency. MPF : Mean power frequency of action. NCS : Nerve conduction study. NCV : Nerve conduction velocity. NS : Non significant. P : Probability. PC : Personal computer. ROM : Range of motion. SD : Standard deviation. SSS : Symptom severity scale. TCL : Transverse carpal ligament. US : Ultrasound. vii

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17 Chapter I Introduction

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19 CHAPTER I INTRODUCTION Carpal tunnel syndrome (CTS) is one of the most common upper limb compression neuropathies, it accounted for approximately 90% of all entrapment neuropathies. It is due to an entrapment of the median nerve in the carpal tunnel at the wrist (Aroori and Spence, 2008). The classic symptoms of CTS include pain and paresthesia along the median nerve distribution. The symptoms reported by patients include sensory disturbances presented as pain, numbness, tingling, and burning sensation. Motor dysfunction is witnessed by a loss of coordination and muscle weakness as noted by decreased grip and pinch strengths. Nocturnal pain, which interrupts the sleep cycle, is often a result of an increase in intra carpal pressure owing to flexion or extension positioning during sleep. Nocturnal symptoms can often be resolved by splinting, shaking, or rubbing the arm and hand (Moraska et al., 2008). There are several treatment options for CTS and they can be broadly categorized into surgical and non-surgical methods. Non-surgical methods are effective in patients with mild to moderate CTS; they are indicated in patients with no muscle weakness, atrophy, or denervation and with only a mild abnormality on nerve conduction studies (Burke et al., 2003). Conservative treatment of about six weeks to twelve weeks can be considered in patients with mild disease. Lifestyle modifications, including decreasing repetitive activity and using ergonomic devices, have been traditionally advocated, but have inconsistent evidence to support their effectiveness. Oral corticosteroids are considered first-line 1

20 therapies, as local corticosteroid injections used for refractory symptoms. Non steroidal anti-inflammatory drugs, diuretics and pyridoxine (vitamin B6) have been shown to be non effective as placebo. Most conservative treatments provide short-term symptoms relief with little evidence supporting long-term benefits. Patients with moderate to severe disease should be considered for surgical evaluation (Leblanc and Cestia, 2011). Werner et al., (2005) compared nocturnal splint use with an ergonomic education program and although they found improvement in both groups, the group treated with splints showed greater improvement at one-year follow-up. A wrist splint helps the limitation of numbness by limiting wrist flexion. Night splinting helps patients' sleep (Michlovitz, 2004). Gerritsen et al., (2002) suggested that 2 prognostic indicators predict benefits from splint wearing; these indicators are CTS complaints of less than 1 year in duration and nocturnal parethesia severity score of 6/10 or less. In physiotherapy there were several ways to treat and control carpal tunnel syndrome, these procedures should be directed specifically towards the pattern of pain, symptoms and dysfunction assessed by the therapist. As such, it may include a range of modalities ranging from soft tissue massage, conservative stretches, exercises, techniques to directly mobilize the nerve tissue, kinesio tape and ultrasonic therapy (Michlovitz, 2004). The kinesio taping method assisted in reducing the edema and pain associated with the syndrome, it may be used to add space correction during acute inflammation, fascia correction for chronic conditions, mechanical correction to apply pressure to a specific area, or select a 2