Efficacy of kinesiotherapy and manual therapy procedures when treating carpal tunnel syndrome

Uvod: Sindrom zapestnega prehoda je najpogostejša periferna utesnitvena nevropatija na zgornjem udu in se izraža kor senzorična in motorična okvara, ki se pojavi zaradi kompresije ali trakcije medianega živca v zapestnem prehodu, ter zajema 90% vseh utesnitvenih nevropatij. Senzorična okvara se odraža kot pojav parastezij (mravljinčenja), ščemenja, bolečine in odrevenelosti po poteku medianega živca, ki zajema palec, kazalec, sredinec in radialno stran prstanca. Ti simptomi se pogosto pojavljajo ponoči, ki pa prenehajo po stresanju prizadete roke. Motorična okvara pa se odraža kot zmanjšana moč prijema z okrnjeno funkcijo prizadete roke. Pri tem se pojavi šibkost mišic, ki izvajajo opozicijo palca, opazi se atrofija palčne kepe, kar ima za posledico nenadne padce stvari iz rok. Namen: Z diplomskim delom smo želeli, na osnovi pregleda literature, predstaviti učinkovitost posameznih fizioterapevtskih postopkov pri obravnavi sindroma zapestnega prehoda. Metode dela: Iskanje literature je bilo opravljeno s pomočjo elektronskih baz podatkov Cochrane library, PEDro in PubMed, ter se pri tem omejili na članke objavljene od leta 2010 do leta 2017. Rezultati: Izbranih je bilo dvanajst randomiziranih kontroliranih raziskav, ki so bile objavljene v angleškem jeziku. V teh raziskavah so avtorji proučevali izboljšanja z vključevanjem različnih manualnih tehnik in vadbe, mobilizacije kit in živca. Ugotovili so večja izboljšanja v prid postopkom mobilizacije medianega živca, mobilizacije zapestnih kosti, masažo, manipulacije fascije, ishemične kompresijske terapije in vadbe, mobilizacije kit in živca. Razprava in sklep: Raziskave so bile težko primerljive med seboj, saj so se postopki zdravljenja razlikovali med seboj. Glede na rezultate ne moremo predlagati najučinkovitejšega pristopa, lahko pa zaključimo, da so ti pristopi učinkovitejši od konvencionalne fizioterapije, ki prav tako izboljšuje simptome in funkcijo pacientov. Za dokazovanje učinkovitosti predstavljenih postopkov je potrebno še nadaljnje raziskovanje.Introduction: The carpal tunnel syndrome is the most common peripheral compression neuropathy of the upper limb and shows itself as a sensory and motor disorder, which occurs due to compression and traction of the median nerve in the carpal tunnel and covers 90 % of all compression neuropathies. Sensory impairment reflects itself as an occurrence of paraesthesia (tingling), itchiness, pain, and numbness down the median nerve, which innervate the thumb, index finger, middle finger, and the radial side of the ring finger. These symptoms often occur during the night but pass as soon as the affected hand is shaken. The motor impairment is reflected in the reduced power of the grasp with the reduced function of the affected hand. This leads to weak muscles that perform the opposition of the thumb and it also leads to the atrophy of the thenar, which results in suddenly dropping things from hands. Purpose: Based on the overview of literature, this paper wishes to present the effectiveness of individual physiotherapeutic procedures in treating the syndrome of the carpal tunnel. Methods: Literature was found with the help of electronic databases Cochrane library, PEDro in PubMed while we focused on articles published from 2010 to 2017. Results: We chose 12 randomized controlled trials that were published in English. The authors of these experiments studied improvements by including various manual techniques and the tendons and nerve gliding exercises. They discovered greater improvements in favour of the procedures of the mobilization of the median nerve, wrist bone mobilization, massage, manipulation of the fascia, ischemic compression therapies, and the tendons and the nerve gliding exercises. Discussion and conclusion: It is hard to compare these results, since the treatment procedures differed from one another. Based on these results we cannot give the most effective approach, but we can conclude that these approaches are more beneficial than conventional physiotherapy, which also have been effective in improving the symptoms and the functions of the patients. In order to prove efficiency of above-mentioned physiotherapeutic procedures further research is necessary