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Category: Physiotheraphy

Physiotheraphy
25 August 2020 by rommer 0 Comments

Carpal Tunnel Syndrome and Its Treatment

CARPAL TUNNEL SYNDROME (WRIST NERVE COMPRESSION)

The structure called the carpal ligament forms a tunnel with the bones of the wrist beneath it, protecting the tendons and nerves responsible for finger movements, thus creating the wrist canal or carpal tunnel. This wrist canal is located at the level of the wrist and is covered by a thick band of tissue at the top. The median nerve, the thickest nerve in the hand, passes through this tunnel. This nerve primarily allows us to feel the thumb, index, middle, and ring fingers and enables some of their movements.

What is Carpal Tunnel Syndrome?

When the tunnel narrows in any way, the median nerve passing through it becomes compressed. This results in some dysfunction in the nerve, causing tingling, burning, and pain in the hand and wrist. This condition is called carpal tunnel syndrome.

What Causes Carpal Tunnel Syndrome?

The pressure on the nerve can occur in several ways. Swelling of the tendon sheaths that bend the fingers, joint fractures and dislocations, soft tissue trauma, vascular and muscular anomalies that narrow the canal volume, and postural reasons such as holding the wrist in a bent position for a long time can lead to the narrowing of the carpal tunnel and cause this syndrome. Carpal tunnel syndrome may develop in approximately 25-35% of pregnant women due to edema, but it often resolves spontaneously after childbirth.

Who Is at Risk for Carpal Tunnel Syndrome?

It is more common in individuals who perform repetitive hand and wrist movements in their work, especially those who perform tasks that stress the wrist in the same manner. Carpal tunnel syndrome is more frequently seen in groups such as housewives who do excessive handwork, employees in banking sectors with frequent typing or computer use, secretaries, and musicians. Additionally, conditions like diabetes, hypothyroidism, rheumatic diseases, obesity, gout, and kidney failure can increase the likelihood of developing this syndrome.

Fractures in the wrist, soft tissue tumors, joint cysts, fatty cysts, and anomalies in muscles and vessels can also lead to compressions in this tunnel. Carpal tunnel syndrome does not have a hereditary characteristic, but it is four times more common in women over 40 years old compared to men.

What Are the Symptoms of Carpal Tunnel Syndrome?

The condition usually starts with pain, which can sometimes radiate to the arm. Along with pain, there may be tingling, sometimes itching sensations, and a feeling of quick fatigue and weakness in the finger movements. The tingling sensations may be severe enough to wake the patient from sleep at night. Patients typically report that raising their arms and shaking their hands or massaging their wrists helps relieve the discomfort. Tingling is most commonly felt in the first three fingers.

If not diagnosed early and preventive measures are not taken, symptoms may worsen, leading to continuous tingling throughout the day. Over time, difficulties in grasping objects may arise, and in more advanced cases, muscle wasting in the palm may occur.

How is Carpal Tunnel Syndrome Diagnosed?

Early diagnosis and treatment are crucial to prevent permanent damage to the median nerve. If permanent damage occurs, the fingers may lose the ability to move.

The median nerve originates from the spinal cord. It can be compressed at any point between the spine and the fingers. The exact location of the problem can only be determined through electromyography (EMG) testing. EMG can identify whether the median nerve is compressed under the carpal ligament, where the compression occurs, and to what extent.

How is Carpal Tunnel Syndrome Treated?

Treatment for carpal tunnel syndrome can be either surgical or non-surgical, depending on the stage of the disease.

If there are no underlying conditions like diabetes or hypothyroidism, it is generally recommended to rest the affected hand and wrist for at least two weeks. Preventing or limiting activities that could worsen the symptoms, and immobilizing the wrist with a splint is important.

If swelling is observed in the wrist, cold therapy should be applied. While ultrasound therapy, laser treatments, B vitamins, and exercise therapies have been tried, there is no conclusive evidence supporting their effectiveness. Pain can be managed with NSAIDs (non-steroidal anti-inflammatory drugs). In cases of persistent pain, corticosteroid or local anesthetic injections may be administered for the wrist.

A wrist splint (resting splint), along with anti-inflammatory medications, should especially be worn at night. If symptoms persist for 6 months or longer, surgical methods should be considered.

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Physiotheraphy
25 August 2020 by rommer 0 Comments

Kyphosis (Hunchback) and Its Treatment

Spinal Alignment from Birth to Old Age

From birth to old age, the sagittal (side) alignment of the spine undergoes continuous changes. During birth, the entire spine, from the neck to the coccyx, is in a forward-bent position. However, as the individual begins to stand upright, first a forward C-shaped curve forms in the lumbar region, followed by a reverse C-shaped curve in the thoracic region. Subsequently, four consecutive reverse curves develop in the neck, back, lumbar spine, and pelvis.

What is Adult Kyphosis?

Also known as hunchback, adult kyphosis is an excessive forward curvature of the spine in the thoracic region. The angle of the vertebrae in the back has surpassed the normal limits.

In normal lateral X-rays, the Cobb angle between the upper endplate of T5 (the 5th thoracic vertebra) and the lower endplate of T12 (the 12th thoracic vertebra) ranges from 10 to 40 degrees. An angle greater than 40 degrees is considered kyphosis.

What Causes Kyphosis?

Kyphosis, which can also develop genetically, has several known causes:

  • Degeneration of the spine due to external factors
  • Degenerative disc diseases caused by osteoporosis
  • Fractures resulting from accidents or trauma
  • Congenital abnormalities (e.g., myelomeningocele)
  • Inflammation and infection in the tissues surrounding the spine
  • Primary spinal infections like tuberculosis
  • Neuromuscular diseases
  • Tumors affecting the spine

What Are the Symptoms of Adult Kyphosis?

The most obvious symptom is the forward curvature of the spine. Common symptoms include:

  • Stiffness and pain in the back and shoulders
  • Constant numbness and weakness in the legs
  • Excessive fatigue in the muscles
  • Postural abnormalities, difficulty standing upright
  • Shortness of breath and difficulty breathing
  • Excessive sensitivity in the spine

How is Adult Kyphosis Diagnosed?

A simple test that families can perform may give an idea of the severity of the condition. If instructing your child to stand upright significantly corrects the visible hunchback, it is likely to be postural kyphosis. However, if the curvature does not correct, professional help should be sought.

For diagnosis, radiological tests are used to measure the angle of kyphotic curvature. In advanced cases, lung function tests should also be conducted. If kyphosis causes other symptoms such as urinary or fecal incontinence, MRI scans should be performed.

Can Hunchback Be Prevented?

The most common cause of hunchback is poor posture. If there are no underlying health conditions, individuals can benefit from exercises aimed at correcting kyphosis. Strengthening the muscles around the abdomen, chest, legs, and spine through exercise can help bring the hunchback into normal limits.

Can Adult Kyphosis Be Treated?

Kyphosis treatment depends on its severity:

  • Mild cases (50-55 degrees): Can improve with regular exercise, proper posture, and correct techniques.
  • Moderate cases (50-70 degrees): A kyphosis brace is recommended in addition to exercise.
  • Severe cases: A surgical consultation may be necessary.

Physical therapy exercises, including reverse hyperextensions, can be beneficial. A kyphosis brace should be used under medical supervision and according to specific indications.

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Physiotheraphy
25 August 2020 by rommer 0 Comments

Tendinitis and Bursitis Treatment


What is Tendinitis?

Tendons are structures where muscles taper into a band and attach to the bone. Tendons are widespread in our body. Due to excessive use, inflammation (non-infectious inflammation) and edema can develop at these attachment points. This condition is called tendinitis.

Tendinitis and bursitis commonly affect the shoulder, elbow, wrist, hip, knee, and ankle. They usually occur suddenly and can cause severe pain.

Tendinitis is damage to the muscle tendons due to excessive use, improper use, and repetitive movements. When treated early, tendinitis heals quickly. In some cases, it can recur and become chronic.

What is Bursitis?

Bursae are small sac-like structures that act as cushions between bones, muscles, tendons, and skin. Bursitis appears as painful swelling in joint areas. Inflammation of these structures is very painful and is called bursitis.

Causes of Tendinitis and Bursitis

Tendinitis can result from sudden injuries but is often caused by repeated minor trauma. The most common cause of bursitis is excessive use of a joint or direct impact on the bursa. Common causes include:

  • Typing on a keyboard for prolonged periods and performing repetitive cutting/chopping motions
  • Using hand tools such as scissors or pliers for extended periods
  • Playing tennis and performing repetitive backhand strokes
  • Aging, which increases the incidence of tendinitis and bursitis in the legs, hips, and elbows
  • Conditions such as gout, diabetes, blood, and kidney diseases

How Are Tendinitis and Bursitis Diagnosed?

A good medical history and a thorough physical examination are essential for diagnosis. Patients usually present with pain. In tendinitis, tenderness is detected along the tendon or its sheath. Pain occurs when the affected muscle moves against resistance.

Bursitis and tendinitis are more common in professions such as carpentry, gardening, musicians, and athletes.

In early cases, imaging tests such as MRI or ultrasound are usually unnecessary. If pain persists or an underlying systemic disease is suspected, imaging and blood tests should be conducted. If bursitis results from an infection, drainage of the inflammation may be required.

Treatment of Tendinitis and Bursitis

Treatment depends on the cause. If overuse or injury is responsible, appropriate measures should be taken. In some cases, joint protection and support may be necessary. General treatment principles include:

  • Rest: The affected joint should be rested for a short period. If the issue involves major limbs (e.g., Achilles tendon), weight-bearing should be minimized.
  • Cold application: Applying ice for 10-15 minutes, 2-4 times daily, can be beneficial.
  • Medications: NSAIDs (non-steroidal anti-inflammatory drugs) and pain relievers.
  • Steroid injections: May provide short-term relief in some cases.
  • Drainage: If an infection is present, needle aspiration and appropriate antibiotics are necessary.
  • Support: Orthoses can be used to reduce joint load.
  • Physical therapy: Strengthening and stretching exercises may be required for persistent tendinitis.

Since bursitis and tendinitis can be prolonged conditions, joint stiffness (such as frozen shoulder) may develop, requiring physical therapy. Heat/cold applications, massage, and personalized exercise programs yield positive results.

Preventive Measures for Tendinitis and Bursitis

Individuals who engage in intense sports and exercise have a high risk of developing tendinitis and bursitis. To reduce this risk:

  • Always perform warm-up and stretching exercises before exercising.
  • Avoid rapid and intense exercises; start slowly and gradually increase intensity.
  • Returning to exercise after a long break can cause tendinitis and bursitis. It is better to exercise daily at a lower intensity rather than doing intense workouts once a week.
  • Using proper equipment and sports gear can help reduce the risk.

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