1. step 11
1.1. Review and evaluate
1.2. Group members
1.3. Chairman
1.4. Scribe
1.5. Tutor
1.6. Material
1.7. 10 minutes
2. Step 9
2.1. Review session 3
2.2. visualize the data and theory
2.3. discuss previous objectives
2.3.1. how to determine axonal loss --> EMG
2.3.2. Sensitivity and specificity of the tests
2.4. 20 minutes
3. Step 10
3.1. Management (for the individual)
3.1.1. conservative therapy
3.1.1.1. wrest splinting
3.1.1.1.1. during sleep
3.1.1.1.2. limit the activities that raise the pressure
3.1.1.1.3. mild to moderate cases only
3.1.1.1.4. No significant difference between night and all day use
3.1.1.1.5. neutral - 20 degrees extension
3.1.1.1.6. 1-3 months
3.1.1.1.7. custom made by specialist is recommended
3.1.1.2. steroid
3.1.1.2.1. risks
3.1.1.2.2. proximal or distal
3.1.1.2.3. once every 6 months, 2 times
3.1.1.2.4. 4-12 weeks of symptom relief (short term)
3.1.1.2.5. reduced inflammation
3.1.1.3. oral steroids
3.1.1.3.1. 2-4 weeks (short term use)
3.1.1.3.2. or 10 days
3.1.1.3.3. injection is more recommended
3.1.1.4. NSAIDs
3.1.1.4.1. no significant effect
3.1.1.4.2. not recommended
3.1.1.5. modification of activities in mild cases
3.1.1.6. Yoga
3.1.1.6.1. limited evidence for pain control
3.1.1.7. ultra sound
3.1.1.7.1. low intensity 0.5 watt/cm2 for soft tissue healing
3.1.1.7.2. dilating bv and helping in the healing process
3.1.1.7.3. high intensity for pain reduction, increase tissue elasticity 1.5 watt/cm2
3.1.1.7.4. takes long time so you might lose follow up with the patient
3.1.1.7.5. deep is more effective than superficial
3.1.1.7.6. limited data
3.1.1.8. carpal bone mobilization
3.1.1.8.1. realignment of bones at wrest so there will be less compression at the medial nerve
3.1.1.8.2. manipulation therapy
3.1.1.8.3. good relief of pain
3.1.1.8.4. limited data
3.1.2. surgery
3.1.2.1. more effective
3.1.2.2. performed in out patient setting with localized anesthesia
3.1.2.3. complications
3.1.2.3.1. progressive thenar muscle atrophy
3.1.2.3.2. vacular or nerve injuries
3.1.2.3.3. wound infections
3.1.2.4. for severe cases or failing of conservative therapy
3.1.2.5. open carpal tunnel release
3.1.2.5.1. standard or limited incision toward the med line
3.1.2.5.2. longitudinal cut
3.1.2.5.3. more scarring
3.1.2.5.4. later return to work
3.1.2.5.5. stretching the carpal tunnel fascia
3.1.2.5.6. gives better view to see other tumors or masses
3.1.2.5.7. Mini open carpal tunnel release
3.1.2.6. endoscopic carpal tunnel release
3.1.2.6.1. can't detected masses
3.1.2.6.2. one or two openings
3.1.2.6.3. better recovery and less scarring
3.1.3. follow up
3.1.3.1. once monthly at least
3.1.3.2. educating the patient
3.2. Prevention (for the population)
3.2.1. screening for high risk jobs
3.2.2. modifying the environment
3.2.3. losing wight
3.2.4. changing the job
3.2.5. wearing a splint for 2 night before heavy use
3.2.6. reduce salt intake