OCCUPATIONAL THERAPY INTERVENTION FOR CARPAL

TUNNEL SYNDROME: A CASE STUDY

Introduction
Carpal tunnel syndrome (CTS) can be a debilitating condition, often characterized by pain, weakness, and
numbness in the hand and arm. It commonly affects individuals who engage in repetitive hand
movements or sustain wrist injuries. Occupational therapy plays a crucial role in addressing the
symptoms of CTS and improving overall hand function through a holistic approach.

Jamila, a 39-year-old homemaker, sought help for her persistent hand and shoulder pain following a fall
while cleaning windows at home. She experienced sharp pain and tingling sensations in her right hand,
coupled with weakness and difficulty in gripping objects. These symptoms significantly impacted her
ability to perform daily tasks and prompted her to seek intervention.

Assessment
Clinical Examination
Upon examination, Jamila exhibited limited range of motion (ROM) in the thumb, wrist, and shoulder,
along with reduced grip strength and limited hand functions. Specific assessments, including Tinel's sign,
Phalen's maneuver, and Durkan's test, were positive, indicating compression of the median nerve at the
carpal tunnel.

Diagnosis
Based on the history, clinical examination findings, and positive diagnostic tests, Jamila was diagnosed
with carpal tunnel syndrome. Diagnostic criteria, including BMI calculation, nerve conduction studies,
and evaluation of symptom severity scales, supported the diagnosis.

Treatment Plan
A multidisciplinary treatment approach was adopted to address Jamila's CTS symptoms
comprehensively. The treatment plan included the following components:

1. Occupational Therapy Intervention

Jamila's journey to recovery began with a personalized occupational therapy intervention plan. This
encompassed several key components aimed at addressing her symptoms and improving hand function:
1. Pain Management: Utilizing modalities such as splinting, heat therapy, and therapeutic ultrasound to
alleviate discomfort and promote tissue healing.

2. Range of Motion Exercises: Prescribing therapeutic exercises to improve wrist and thumb mobility,
including gentle stretching and proprioceptive training.

3. Strength Training: Implementing a progressive strengthening program focusing on grip exercises and
functional activities to enhance overall hand function.

4. Activity Modification: Providing education on ergonomic principles and adaptive techniques to

minimize strain during daily activities and alleviate pressure on the median nerve.

5. Education and Self-Management: Empowering Jamila with self-care strategies, stress management
techniques, and energy conservation methods to manage her symptoms independently.

2. Medication
Prescription of analgesics and anti-inflammatory medications to manage pain and inflammation
associated with CTS.

3. Other Interventions
Consultation with a physiotherapist for adjunctive modalities such as ultrasound therapy and manual
therapy.

Referral to a pain management specialist for consideration of corticosteroid injections for symptom
relief.

Outcome
After six weeks of dedicated occupational therapy intervention, Jamila experienced significant
improvement in her symptoms and functional abilities. She reported decreased pain levels, improved
range of motion, and enhanced grip strength, enabling her to resume her daily activities with greater
ease and confidence. Jamila expressed satisfaction with the knowledge and skills acquired during
therapy, feeling empowered to manage her condition effectively in the long term.

Conclusion
Jamila's journey highlights the effectiveness of occupational therapy in managing CTS symptoms and
improving overall hand function. By adopting a multidisciplinary approach and addressing pain
management, therapeutic exercises, and adaptive strategies, individuals like Jamila can achieve favorable
outcomes and regain independence in their daily lives.
In conclusion, occupational therapy serves as a valuable resource in the comprehensive management of
CTS, offering personalized care and support to individuals experiencing this challenging condition.
Through collaborative efforts and tailored interventions, we can empower individuals like Jamila to
overcome the obstacles posed by CTS and live life to the fullest.
 D ISABILITIES OF THE A RM , S HOULDER AND H AND

Please rate your ability to do the following activities in the last week by circling the number below the appropriate response.

NO MILD MODERATE SEVERE

UNABLE
DIFFICULTY DIFFICULTY DIFFICULTY DIFFICULTY

1. Open a tight or new jar. 1 2 3 4 5

2. Write. 1 2 3 4 5

3. Turn a key. 1 2 3 4 5

4. Prepare a meal. 1 2 3 4 5

5. Push open a heavy door. 1 2 3 4 5

6. Place an object on a shelf above your head. 1 2 3 4 5

7. Do heavy household chores (e.g., wash walls, wash floors). 1 2 3 4 5

8. Garden or do yard work. 1 2 3 4 5

9. Make a bed. 1 2 3 4 5

10. Carry a shopping bag or briefcase. 1 2 3 4 5

11. Carry a heavy object (over 10 lbs). 1 2 3 4 5

12. Change a lightbulb overhead. 1 2 3 4 5

13. Wash or blow dry your hair. 1 2 3 4 5

14. Wash your back. 1 2 3 4 5

15. Put on a pullover sweater. 1 2 3 4 5

16. Use a knife to cut food. 1 2 3 4 5

17. Recreational activities which require little effort

(e.g., cardplaying, knitting, etc.). 1 2 3 4 5

18. Recreational activities in which you take some force

or impact through your arm, shoulder or hand
(e.g., golf, hammering, tennis, etc.). 1 2 3 4 5

19. Recreational activities in which you move your

arm freely (e.g., playing frisbee, badminton, etc.). 1 2 3 4 5

20. Manage transportation needs

(getting from one place to another). 1 2 3 4 5

21. Sexual activities. 1 2 3 4 5

 D ISABILITIES OF THE A RM , S HOULDER AND H AND

QUITE
NOT AT ALL SLIGHTLY MODERATELY EXTREMELY
A BIT

22. During the past week, to what extent has your arm,
shoulder or hand problem interfered with your normal
social activities with family, friends, neighbours or groups?
(circle number) 1 2 3 4 5

NOT LIMITED SLIGHTLY MODERATELY VERY

AT ALL LIMITED LIMITED LIMITED UNABLE

23. During the past week, were you limited in your work
or other regular daily activities as a result of your arm,
shoulder or hand problem? (circle number) 1 2 3 4 5

Please rate the severity of the following symptoms in the last week. (circle number)

NONE MILD MODERATE SEVERE EXTREME

24. Arm, shoulder or hand pain. 1 2 3 4 5

25. Arm, shoulder or hand pain when you

performed any specific activity. 1 2 3 4 5

26. Tingling (pins and needles) in your arm, shoulder or hand. 1 2 3 4 5

27. Weakness in your arm, shoulder or hand. 1 2 3 4 5

28. Stiffness in your arm, shoulder or hand. 1 2 3 4 5

SO MUCH
NO MILD MODERATE SEVERE DIFFICULTY
DIFFICULTY DIFFICULTY DIFFICULTY DIFFICULTY THAT I
CAN’T SLEEP

29. During the past week, how much difficulty have you had
sleeping because of the pain in your arm, shoulder or hand?
(circle number) 1 2 3 4 5

STRONGLY DISAGREE NEITHER AGREE AGREE STRONGLY

DISAGREE NOR DISAGREE AGREE

30. I feel less capable, less confident or less useful

because of my arm, shoulder or hand problem.
(circle number) 1 2 3 4 5

DASH DISABILITY/SYMPTOM SCORE = ( [(sum of n responses / n) - 1] x 25, where n is the number of completed responses. )

A DASH score may not be calculated if there are greater than 3 missing items.
 D ISABILITIES OF THE A RM , S HOULDER AND H AND

THE
DA SH

INSTRUCTIONS

This questionnaire asks about your

symptoms as well as your ability to
perform certain activities.

Please answer every question, based

on your condition in the last week,
by circling the appropriate number.

If you did not have the opportunity

to perform an activity in the past
week, please make your best estimate
on which response would be the most
accurate.

It doesn’t matter which hand or arm

you use to perform the activity; please
answer based on your ability regardless
of how you perform the task.
 D ISABILITIES OF THE A RM , S HOULDER AND H AND

WORK MODULE (OPTIONAL)

The following questions ask about the impact of your arm, shoulder or hand problem on your ability to work (including homemaking
if that is your main work role).
Please indicate what your job/work is: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
❐ I do not work. (You may skip this section.)

Please circle the number that best describes your physical ability in the past week. Did you have any difficulty:

NO MILD MODERATE SEVERE

UNABLE
DIFFICULTY DIFFICULTY DIFFICULTY DIFFICULTY

1. using your usual technique for your work? 1 2 3 4 5

2. doing your usual work because of arm,

shoulder or hand pain? 1 2 3 4 5

3. doing your work as well as you would like? 1 2 3 4 5

4. spending your usual amount of time doing your work? 1 2 3 4 5

SPORTS/PERFORMING ARTS MODULE (OPTIONAL)

The following questions relate to the impact of your arm, shoulder or hand problem on playing your musical instrument or sport or
both.
If you play more than one sport or instrument (or play both), please answer with respect to that activity which is most important to
you.
Please indicate the sport or instrument which is most important to you:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
❏ I do not play a sport or an instrument. (You may skip this section.)

Please circle the number that best describes your physical ability in the past week. Did you have any difficulty:

NO MILD MODERATE SEVERE

UNABLE
DIFFICULTY DIFFICULTY DIFFICULTY DIFFICULTY

1. using your usual technique for playing your

instrument or sport? 1 2 3 4 5

2. playing your musical instrument or sport because

of arm, shoulder or hand pain? 1 2 3 4 5

3. playing your musical instrument or sport

as well as you would like? 1 2 3 4 5

4. spending your usual amount of time

practising or playing your instrument or sport? 1 2 3 4 5

SCORING THE OPTIONAL MODULES: Add up assigned values for each response; divide by
4 (number of items); subtract 1; multiply by 25.
An optional module score may not be calculated if there are any missing items.

©IWH & AAOS & COMSS 1997