ASK A PHYSICAL THERAPIST

Q: Doctor I have carpal tunnel syndrome, how can physical therapy help? I am a 33 years old female.

A: Carpal tunnel syndrome (CTS) arises from the compression of the median nerve within the carpal tunnel of the wrist. The normal pressure within this tunnel ranges between 3-7mm Hg, but in CTS, it can surpass 30mm Hg.

Symptoms typically manifest in the thumb, index finger, middle finger, and the radial half of the ring finger, with pain possibly extending up the arm, shoulder, and neck. With progression, symptoms may include night pain, hand weakness, reduced fine motor coordination, grip strength, clumsiness, diminished wrist mobility, and thenar atrophy.

While diagnosing CTS is usually swift and treatment effective, determining the optimal treatment approach, integrating clinical, functional, and anatomical considerations, remains a challenge. Various factors can lead to CTS, broadly categorized into conditions decreasing the carpal tunnel's size and those augmenting its contents.

The pathophysiology of CTS involves compression and traction mechanisms, resulting in increased pressure, venous outflow obstruction, local edema, and compromise to the median nerve's microcirculation. This leads to nerve dysfunction, myelin sheath and axon lesions, and inflammation of surrounding connective tissues, exacerbated by repetitive wrist motion and tendon inflammation.

Idiopathic CTS, more prevalent in females aged 40-60, often bilateral, is associated with synovial membrane hypertrophy of flexor tendons due to connective tissue degeneration.

Clinical presentation includes gradual onset of tingling or numbness in the affected hand's median nerve distribution, worsened by gripping objects or at night. As CTS progresses, symptoms may include constant tingling, burning pain, weakness, and muscle atrophy in the thenar eminence, leading to clumsiness and grip strength loss.

Conservative treatment, especially if CTS is identified early, includes modifying wrist movements, ergonomic adjustments, activity modification, rest, and physical therapy. Manual therapy techniques such as soft tissue mobilization, carpal bone manipulation, and median nerve mobilization, along with modalities like ultrasound and electromagnetic field therapy, can be beneficial. Splinting may also be recommended.


Q: Doctor is physical therapy helpful in knee osteoarthritis? And please guide about the condition.

A: Knee osteoarthritis (OA), also known as degenerative joint disease, typically results from the gradual erosion of articular cartilage due to wear and tear. Predominantly affecting elderly individuals, it can be categorized into primary and secondary forms, Primary OA involves articular degeneration without an identifiable cause. Secondary OA is linked to specific causes such as abnormal force distribution across the joint, as seen in post-traumatic injuries, or abnormal cartilage conditions like rheumatoid arthritis (RA).

This chronic joint disorder affects not only the knees but also the hands, hips, and spine, with symptoms varying in intensity and progressing slowly. Typical clinical symptoms include Gradually onset knee pain worsening with activity, Knee stiffness and swelling, Pain after prolonged periods of rest or sitting, Cracking or crepitus with joint movement

Treatment for knee OA starts conservatively and advances to surgical options if conservative measures fail. While medications may slow RA progression and other inflammatory conditions, there are no established disease-modifying agents for knee OA. Knee OA can be primary, resulting from age-related cartilage degeneration, or secondary, due to identifiable causes such as obesity, joint instability, previous injuries, or metabolic factors.

The knee is a synovial joint comprising the tibiofemoral and patellofemoral joints. OA can affect either or both of these articulations, often beginning with the patellofemoral joint. OA progression involves the deterioration of type II articular cartilage, disrupting its equilibrium and leading to collagen disorganization, cartilage cracking, and erosion.

As OA advances, ligament laxity and muscle atrophy may accompany the disease, manifesting as pain upon movement, morning stiffness, reduced range of motion, and joint enlargement. Knee OA severity can be graded from 0 to 4, with grade 4 indicating severe OA characterized by reduced joint space, extensive cartilage loss, and significant pain. Diagnosis involves blood tests, physical examination, X-rays, arthrocentesis, arthroscopy, and MRI scans to assess cartilage breakdown, joint space narrowing, and other abnormalities.

Treatment encompasses conservative and surgical management, with conservative measures prioritized initially. Physiotherapy is essential for all OA patients, focusing on self-management, pain reduction, functional optimization, and disease modification. Exercise, under physiotherapist guidance initially, is effective for pain management and physical improvement. Group exercises combined with home routines have shown enhanced efficacy.Ultimately, movement and physical activity are crucial for managing knee OA, improving joint mobility, quality of life, and mental well-being.

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