Síndrome do Túnel do Carpo: avaliação e intervenção fisioterapêutica com interface entre a mão e a coluna vertebral

Abstract

Carpal Tunnel Syndrome (CTS) is a most common compression neuropathy of the median nerve of the upper extremity. The symptoms are varied and their presentation is usually bilateral. It is characterized by pain, tingling and / or feeling of numbness in the hand, wrist and first 3 fingers and tending to get worse at night. With the progression of symptoms, pain and numbness may be felt during the day intermittently or triggered by daily activities. In many patients the pain becomes constant and edema of the hands, lack of dexterity in handling objects and falling objects are reported. In advanced stages it is possible to observe weakness due to atrophy of the tenar musculature. In association with hand symptoms, 45% of individuals with CTS also report pain in the proximal areas of the upper extremity. Such symptoms may be evidence of damage to the cervical nerve roots, which would explain the symptomatic picture along the upper and cervical limbs. Thus, the treatment of compression injuries should be directed to all vulnerable points along the nerve, such as: wrist, elbow and cervical. Electroneuromyography (ENMG) is an invasive exam considered the gold standard in the diagnosis of CTS. However, this test has a high rate of false positives. Dynamometry and surface electromyography (EMG) are non-invasive techniques capable of evaluating and measuring electromyographic strength and activation and providing objective information useful for determining normative patterns and injury indicators. And, for a more targeted evaluation of the hands, the ICF Core Set for Hand Conditions Brief (BCS-HC) was developed, which verifies the impacts of function, activity and participation through the concepts of the International Classification of Functionality, Disability and Health (CIF ). Thus, we seek to investigate whether the use of non-invasive techniques (EMG and dynamometry) are able to detect changes in the hand muscles with CTS that may suggest neural distress. In addition, to verify whether a physiotherapy protocol based on segmental stabilization techniques, cervical and neural mobilization is more effective than classical therapeutic exercises in reducing symptoms, evolution of the functional state and alteration of the electromyographic activity of the hands of women with CTS. As well as verifying the applicability of BCS-HC by linking the concepts of the Patient rated wrist evaluation (PRWE) and Boston Carpal Tunnel Questionnaire (BCTQ) and determining whether there is an association between the ICF concepts and the STC questionnaires.