Tuesday, June 4, 2019

Degrees Of Carpal Tunnel Syndrome Health And Social Care Essay

Degrees Of wrist b bingle bone bone Tunnel Syndrome Health And Social C be Essay articulatio radiocarpea bone turn over syndrome is a more or less common contraction neuropathy of the upper extremity. It is get under ones skind by compression of median value middle in the carpal bone bone turn over.Women atomic number 18 more comm only when abnormal than men. It is commonly seen in age host between 30 and 60 years. carpal bone delve syndrome ordinarily occurs due to excessive use of the hands and occupational exposure to repeated trauma.Average cross sectional arena of the carpal turn over is 1.7 cm2 with the wrist in neutral position. Passive flexure and extension of the wrist has been increased the carpal delve pressure. radiocarpal joint extension increases carpal dig pressure more than the wrist bend. Any space occupying mass or swelling of the structures in the cut into in like manner causes pressure on the median plaque.Mostly, the cause of carpal bu rrow syndrome is unknown. Any condition which causes pressure on median philia at the wrist will result in carpal tunnel syndrome. Obesity, pregnancy, hypothyroidism, arthritis, diabetes and trauma are the common conditions that place to carpal tunnel syndrome. Repetitive work such as uninterrupted typing which result in tendon inflammation raise also cause carpal tunnel symptoms. Carpal tunnel syndrome due to repetitive activities has referred to one of the repetitive stress injuries. In some rare diseases such as amyloidosis, leukemia, multiple myeloma, and sarcoidosis, deposition of abnormal substances in and around the carpal tunnel leads to governing body irritation.Prolonged flexion or extension of the wrists under the patients head or pillow during sleep is believed to contribute to the prevalence of nocturnal symptoms. Usually patient complaints ail, numbness and tingling sensation in the hand and fingers. Symptoms worsening at night typically awakening the patient or o ccurring on bunching up the hand for tasks such as writing.Carpal tunnel syndrome is the most common cause of acroparaesthesiae often annoying and paraesthesiae whitethorn be the only symptoms for many months or years. The syndrome is essentially a sensory one the passing game or impairment of superficial sensation affects the thumb, tycoon and middle fingers and whitethorn be or may not split the ring finger. on that point may be wasting and weakness of the thenar muscles. Weakness and atrophy of the abductor pollicis brevis and other muscles supplied by median nerve occur in only the most advanced cases of compression.Degrees of carpal tunnel syndrome are classified as dynamic, mild, harbour and relentless. The pathophysiology of carpal tunnel syndrome is typically demyelination. Secondary axon loss may baffle in more severe cases. With 20 to 30 mm hg compression, the initial insult is a reduction in epineural blood flow. With wrist extension, intracarpal pressures routinel y measure atleast 33 mm hg and often upto 110 mm hg in patients with carpal tunnel syndrome. Edema in the epineurium and endoneurium is caused by continue or increased pressure.Carpal tunnel syndrome diagnosed by detailed history collection, phalen maneuver, percussion running game, two point discrimination test, vibrometry, monofilament test, distal sensory latency and conductivity velocity, distal motor latency conduction, upper limb tension tests. X-ray is taken to check for arthritis and fracture. If there is a suspected medical condition that is associated with carpal tunnel syndrome, laboratory tests may be done.This condition could be mistaken for a brachial neuritis due to cervical intervertebral disc prolapse at C5 C7 level. nervus conduction tests on the median nerve help to localize the lesion in the tunnel.Both conservative and surgical centering options are available in order to subvert pressure over median nerve. The current conservative interpositions include n on steroidal anti inflammatory drugs, sometimes rest, local shaft of corticosteroids, occupation modification, ultrasonography therapy, carpal bone mobilization, magnetic therapy, night and/or daytime wrist splint positioned at 0 to 15 degrees of extension, nerve and tendon go exercises. Anyone of the measures alone or in combination can be effective in treating early carpal tunnel syndrome.Tendon glide exercises are performed to lubricate and increase glide of the flexor muscle pollicis longus, flexor digitorum superficialis and flexor digitorum profundus tendons. They are best performed with the hand elevated to concurrently control local edema. Median nerve gliding exercises and the upper limb tension test with median nerve bias can be used as intercession techniques.Modality treatment can also control symptoms and enhance the therapeutic exercise program.Exercise intervention for carpal tunnel syndrome focuses on mobility and strengthening without producing an exacerbat ion. Stretches for the extrinsic and intrinsic muscles are electro domineering for several times each day. If working, a patient should perform them before work. They should be performed slowly and gently the patient feel only a pleasant stretching sensation. In workplace, modification of the job site or collar ergonomic redesign is typically the most helpful approach. In addition yoga, chiropractics, optical maser treatment extradite been advocated.Surgery is indicated in advanced cases with objective sensory loss and /or weakness or atrophy of the abductor pollicis brevis. In severe cases surgical division of the transverse carpal ligament usurps the condition. Surgical management includes open carpal tunnel release and endoscopic release. It aims to decompress nerve, to improve excursion and to hold on flexor damage.Splinting is the most popular method of conservative management of carpal tunnel syndrome. Splints are recommended by the American Academy of Neurology for the Carpal tunnel syndrome with light and moderate pathology. immobilizing of the wrist joint in a neutral position with splint will increase the carpal tunnel garishness and minimize the median nerve pressure. Wrist Splinting in a neutral position will help burn and may even completely relieve Carpal tunnel syndrome (Slater RR et al 1999). sonography therapy is more useful in the management of Carpal tunnel syndrome. It has the potential to accelerate normal resolution of inflammation. ultrasound therapy elicit anti inflammatory and meanspiritedder stimulating personal effects. ultrasound therapy accelerates the healing process in damaged tissues.Pulsed ultrasonography therapy with the intensity of 1.0 w/cm2, 14 for fifteen legal proceeding per session has significantly improved subjective symptoms in patients with carpal tunnel syndrome (Ebenbichler GR et al).Nerve and tendon gliding exercises are used in conservative treatment of carpal tunnel syndrome to shine adhesions an d to regulate venous return in nerve bundles (Rozmaryn et al).Nerve and tendon gliding exercises may maximise the relative movement of the median nerve within the Carpal tunnel and the excursion of flexor tendon relative to one another (Rempel D, Manojlovic R et al).Wrist splint along with nerve and tendon gliding exercises showed significant improvement in trim down symptoms in Carpal tunnel syndrome. (Akalin et al)NEED FOR THE STUDYUltra sound therapy, splints, nerve and tendon gliding exercises are significantly effective in reducing symptoms in the treatment of Carpal tunnel syndrome. Combination of mixed treatments is also useful in reducing symptoms in Carpal tunnel syndrome. Ultrasound therapy helps to increase healing process in damaged tissue.This psychoanalyse aimed to ascertain out the effect of Ultrasound therapy in reducing trouble in patients with Carpal tunnel syndrome.STATEMENT OF THE PROBLEMEffect of Ultrasound Therapy in reducing pain in patients with Carpal t unnel syndrome.KEY WORDSCarpal tunnel syndromeUltrasound therapySplintExercisesPainVisual analogue crustal plate ( vas) laborTo find out the Effect of Ultrasound Therapy in reducing pain in patients with Carpal Tunnel Syndrome.OBJECTIVETo study the Effect of Ultrasound Therapy in reducing pain in patients with Carpal Tunnel Syndrome.HYPOTHESIS1.6.1. NULL HYPOTHESISThere is no significant effect of Ultrasound Therapy, Splint and Exercises in reducing pain in patients with Carpal Tunnel Syndrome.There is no significant effect of Splint and Exercises in reducing pain in patients with Carpal Tunnel Syndrome.There is no significant difference between the effect of Ultrasound Therapy, Splint and Exercises and Splint and Exercises in reducing pain in patients with Carpal Tunnel Syndrome.1.6.2. ALTERNATE HYPOTHESISThere is significant effect of Ultrasound Therapy, Splint and Exercises in reducing pain in patients with Carpal Tunnel Syndrome.There is significant effect of Splint and Exercis es in reducing pain in patients with Carpal Tunnel Syndrome.There is significant difference between the effect of Ultrasound Therapy, Splint and Exercises and Splint and Exercises in reducing pain in patients with Carpal Tunnel Syndrome.II.REVIEW OF LITERATURECARPAL TUNNEL SYNDROMEDAVID A FULLER, MD, et al (2010)Stated that carpal tunnel syndrome is the most common entrapment neuropathy. The syndrome is characterised by pain, paraesthesia, and weakness in the median nerve distribution of the hand. The etiology of carpal tunnel syndrome is multifactorial which is contributed by dissimilar degrees of local and systemic factors. Symptoms of carpal tunnel syndrome are due to ischemia and impaired axonal transport of the median nerve which results from median nerve compression at the wrist. (Lunborg G, Dahlin LB 1992). Elevated pressure inside the carpal tunnel leads to compression.HARVEY SIMON, MD et al, (2009)Stated that carpal tunnel syndrome is considered as an inflammatory disorde r caused by medical conditions, physical injury or repetitive stress.JEFFREY G NORVELL, MD et al (2009)Stated that carpal tunnel syndrome (CTS) is caused predominantly by median nerve compression at the wrist because of hypertrophy or oedema of the flexor synovium. Pain is thought to be secondary to nerve ischemia rather than impart physical damage of the nerve.S.BRENT BROTZMAN, MD (2003)Explained that degree of the carpal tunnel syndrome as dynamic, mild moderate and severe. In mild cases, patients has intermittent symptoms, decreased light touch, positive digital compression test and positive tinel sign or phalen test may or may not be present. In moderate cases, patients attain frequent symptoms, decreased vibratory sense, muscle weakness, positive tinel sign, phalen test and digital compression test.GERRITSEN AA, DE KROM MC, STRUIJS MA, ET AL (2002)Stated that carpal tunnel syndrome (CTS) is caused by median nerve compression at the wrist and is considered to be the more commo n entrapment neuropathy. Symptoms of carpal tunnel syndrome include pain, numbness or tingling sensation, paraesthesia, involving the fingers innervated by the median nerve. (Bakhtiary AH, Rashidy teem AR et al 2004)GELBERMAN RH, HERGENROEDER PT, HARGENS AR, RYDEVIK B, LUNDBORG G, BAGGE U (1981)Fracture callus, osteophytes, anomalous muscle bodies, tumours, hypertrophic synovium, and infection as well as gout and other inflammatory conditions can arrive increased pressure within the carpal tunnel. Extremes of wrist flexion and extension also elevate pressure within the carpal tunnel. Intraneural blood flow is affected by compression on nerve. Venular blood flow in a nerve is reduced by pressure as low as twenty dollar bill to thirty mm Hg. At level of thirty mm Hg, axonal transport is impaired. At forty mm Hg, neurophysiologic changes manifested as sensory and motor dysfunctions are present. Any further increase in pressure will produce sensory and motor block. At level of sixty t o eighty mm Hg, complete cessation of intraneural blood flow is seen. In one study, the carpal tunnel pressure in patients with carpal tunnel syndrome averaged thirty two mm Hg, compared with only about two mm Hg in control subjects.RH GELBERMAN, AR HARGENS, GN LUNDBORG, PT HERGENROEDER et al, (1981)Measured intra carpal canal pressures with the wick catheter in 15 patients with carpal tunnel syndrome and in 12 control subjects. The average pressure in the carpal tunnel was raised significantly in the patients with carpal tunnel syndrome. When the wrist was in neutral position, the mean pressure was 32 millimeters of mercury. With ninety degrees of wrist flexion the pressure raised to 94 millimeters of mercury. While with ninety degrees of wrist extension the average pressure was 110 millimeters of mercury. The pressure of carpal canal in the control subjects with the neutral position of wrist was 2.5 millimeters of mercury with wrist flexion the carpal canal pressure rise to 31 mil limeters of mercury, and with wrist extension it increased to 30 millimeters of mercury.GEORGE S. PHALEN M.D, et al (1966)Stated that diagnosed Carpal tunnel syndrome has been made in 654 hands of 439 patients during the last seventeen years. The typical patient with this syndrome is a middle-aged housewife with numbness and tingling in the thumb and index, long, and ring fingers, which is worse at night and worse after excessive activity of the hands. The sensory disturbances both objective and subjective must be directly related to the sensory distribution of the median nerve distal to the wrist but pain may be referred proximal to the wrist as high as the shoulder. There is usually a positive tinel sign over the median nerve at the wrist, and the wrist flexion test is also usually positive. About half of the patients also have some degree of thenar atrophy.In clinical practice, Carpal tunnel syndrome is the most commonly seen entrapment mononeuropathy which is caused by median ne rve compression at the wrist (PHALEN 1966, GELBERMAN et al 1998). Usually patients show one or more symptoms of hand weakness, pain, numbness or tingling in the hand, especially in the thumb, index and middle fingers (SIMOVIC and WEINBERG 2000). Symptoms are worst during night time and often wakeup the patient.WILLIAM C. SHIEL JR., MD.FACP, FACR, et alStated that the cause of the carpal tunnel syndrome is unknown. Any condition which causes pressure on the median nerve at the wrist will result in carpal tunnel syndrome. Common conditions such as obesity, pregnancy, hypothyroidism, arthritis, diabetes, and trauma can lead to carpal tunnel syndrome. Repetitive work such as uninterrupted typing result in tendon inflammation can also cause Carpal tunnel symptoms. In some rare diseases such as amyloidosis, leukemia, multiple myeloma, and sarcoidosis, deposition of abnormal substances in and around the carpal tunnel leads to nerve irritation.MEDIAN NERVELUNDBORG G, DAHLIN LB, et al (1996) Stated that throughout the extremity movement, mobility of the peripheral nerve changes and longitudinal movement of the median nerve mostly occur in the carpal tunnel. In Carpal tunnel syndrome, this physiologic mobility of the median nerve disappears.REMPEL D, MANOJLOVIC R, LEVINSOHN DG, et al (1994)Stated that during the exercise there may be redistribution of the point of maximum compression on the median nerve. This milking effect would promote venous return from the median nerve, thus decreasing the pressure inside the perineurium.NAKAMICHI AND S. TACHIBANA et alConducted a study the motion of median nerve in patients with carpal tunnel syndrome and normal subjects. Median nerve motion was assessed by axial ultrasonographic imaging the mid carpal tunnel. They concluded that wrist of patients with Carpal tunnel syndrome showed less sliding which indicates that physiological motion of the nerve is restricted. This decrease in nerve mobility may be of implication in the pathophy siology of carpal tunnel syndrome.ULTRASOUND THERAPYBAKHTIARY AH, RASHIDY-POUR A et al (2004)Conducted a study to compare the effect of Ultrasound and laser therapy in patients with mild to moderate idiopathic carpal tunnel syndrome. By electromyography findings, 90 hands in 50 consecutive patients with carpal tunnel syndrome were corroborateed and allocated randomly in two groups. One group received low level laser therapy and the other group received ultrasound therapy. Ultrasound treatment (pulsed 14, 1.0 W/cm2, 1 MHz, 15 min/session) and low level laser therapy (infrared laser, 830nm, 9 Joules, at five points) were given to the carpal tunnel for fifteen daily treatment sessions. Ultrasound group showed more significant improvement than low level laser therapy group in motor latency, motor action potential amplitude, finger nobble strength, and pain reduction. Effects were also sustained in the follow-up period. They concluded that ultrasound therapy was more effective than las er therapy in the management of carpal tunnel syndrome.EBENBICHLER GR, RESCH KL et al (1998)Studied the efficacy of Ultrasound therapy in patients with mild to moderate idiopathic Carpal tunnel syndrome. Ultrasound with parameters 1MHZ, 1.0 W/cm2 pulsed mode 14, 15 minutes per session was applied over the carpal tunnel and compared with Sham Ultrasound. Actively interact ultrasound group showed significant improvement than sham treated wrists in both subjective symptoms and electroneurographic variables. To confirm the usefulness of ultrasound therapy for Carpal tunnel syndrome, more studies are needed. Additional randomized trials comparing conservative therapies for Carpal tunnel syndrome would be useful in selecting appropriate treatments for individual patients.EL HAG M, COGHLAN K, CHRISMAS P et al (1985)Stated that Ultrasound could elicit anti-inflammatory and tissue-stimulating effects as already shown in clinical trials and experimentally (Byl et al 1992, Young and Dyson 199 0). In this way, Ultrasound has the potential to accelerate normal resolution of inflammation (Dyson 1989).The results of these studies confirm that Ultrasound may accelerate the healing process in damaged tissues. In mild to moderate carpal tunnel syndrome patients, these mechanisms may explain their findings including pain relief, increased grip and pinch strength, and changed electrophysiological parameters toward normal determine better than Laser therapy.WRIST SPLINTWrist splints help to keep the wrist straight and reduce pressure on the compressed nerve. Doctor may recommend the patients to wear wrist splints either at night, or both day and night, although patient may find that they get in the way when they are doing their daily activities. Some research indicates that ultrasound treatment may help to reduce the symptoms of carpal tunnel syndrome. (BUPAS health in arrangement team 2010)BRININGER TL, ROGERS JC et al (2007)Fabricated customized neutral splint and nerve and ten don gliding exercises is more effective than wrist cock up splint and nerve and tendon gliding exercises in reducing symptoms and improving functional status in the treatment of Carpal tunnel syndrome.GERRITSEN AA, DE KROM MC, STRUIJS MA, et al (2002)Immobilization of the wrist joint in a neutral position with a splint will maximizes carpal tunnel volume and minimize the pressure performing on median nerve.AKALIN E, EL O, SENOCAK O, et al (2002)Compared the effect of wrist splint alone to wrist splint with nerve and tendon gliding exercises in the treatment of carpal tunnel syndrome. In their study, both groups showed significant improvement in clinical parameters, functional status outmatch and symptom severity scale. They also describe significant improvement only in pinch strength in the group with wrist splint in combination with exercises compared with the wrist splint group.MANENTE G, TORRIERI F, et al (2001)Stated that wearing a specially designed wrist splint at night time for four weeks was more effective than no treatment in reducing the symptoms of Carpal tunnel syndrome.SLATER RR, et al (1999)Stated that splinting the wrist in a neutral position will help to reduce and may even completely relieve carpal tunnel syndrome symptoms.SAILER SM, et al (1996)Stated that the optimal splinting regimen depends on the patients symptoms and preferences. To prevent prolonged wrist flexion or extension, night splint use is recommended.BURKE DT, STEWRT GW, CAMBER A, et Al (1994)Stated that carpal tunnel syndrome is the commonest compression neuropathy in the upper limb. Several studies have demonstrated the effect of wrist splint in reducing the symptoms of carpal tunnel syndrome. But the chosen angle of immobilization has varied in the management of carpal tunnel syndrome. Wick catheter measurements of carpal tunnel pressures suggest that the neural position has less pressure and, therefore, greater potential to provide relief from symptoms.KRUGER VL, kraft pap er GH, et al (1991)Stated that wrist splint at a neutral angle helps to decrease repetitive flexion and rotation, thereby relieving mild soft tissue swelling or tenosynovitis. Splinting is most effective when it is applied within three months of the onset of symptoms.NERVE AND TENDON GLIDING EXERCISESBAYSAL O, ERTEMK, YOLOGLUS, ALTAY Z, KAYHANA et al (2006)Stated that combination of ultrasound therapy, splinting and exercises is a preferable and an efficacious treatment for patients with carpal tunnel syndrome.ROZMARYN LM, et al (1998)Used nerve and tendon gliding exercises in conservative treatment models to decrease adhesions developed in the carpal tunnel and regulate venous return in the nerve bundles. They reviewed more than 200 hands under consideration for carpal tunnel decompression. Altogether 71% of the patients who were not offered gliding exercises went forward to surgery only 43% of the gliding exercise group was felt to require surgery.SERADGE et al (1995)Stated that i ntermittent active wrist and finger flexion-extension exercises reduce the pressure in the carpal tunnel.SZABO et al (1994)Showed that the relationship between median nerve and flexor tendon excursion was consistently linear. They suggested active finger motion of the median nerve and flexor tendons in the vicinity of the wrist to prevent adhesion formation even if the wrist is immobilized.REMPEL D, MANOJLOVIC R, LEVINSOHN DG, et al (1994)Stated that the median nerve movement is increased by nerve and tendon gliding exercises in the carpal tunnel and the flexor tendons excursion is increased in relative to one another.TOTTEN AND HUNTER, et al (1991)Proposed a series of exercises enhancing the gliding of the median nerve and tendon at the carpal tunnel for management of postoperative Carpal tunnel syndrome. They also suggested these exercises for non-operative Carpal tunnel syndrome.LAMINA PINAR, SAIT ADA AND NEVIN GUNGOR ET ALStated that nerve and tendon gliding exercises include in conservative therapy approaches showed more rapid pain reduction and greater functional improvement in grip strength.HANNAH RICE MYERS, et alStated that carpal tunnel exercises reduce the tension on the tendons in the tunnel and strengthen the weakened muscles of wrist and forearms. Even though nerve and tendon gliding exercises are effective when used alone, they have a greater effect when used along with other intervention such as splint. For people who are involving jobs with holding their hands in a fixed position throughout the day such as typing secretaries, these exercises may help to prevent carpal tunnel syndrome from developing.optical ANALOGUE SCALEPOLLY E. BIJUR PHD, WENDY SILVER MA, E. JOHN GALLAGHER MD et al (2008)Conducted to study to assess the reliability of the visual analogue scale (VAS) for acute pain measurement as assessed by the intraclass correlation coefficients (ICC) appears to be high. The results showed that the Visual analogue scale (VAS) is sufficient ly reliable to be used to assess acute pain.capital of Minnesota S. MYLES, MBBS, MPH, MD, FFARCSI, et al (1999)Stated Visual analog scale (VAS) is a tool widely used to measure pain. A patient is asked to indicate his/her perceived pain intensity (most commonly) along a 100 mm horizontal line, and this rating is then measured from the left edge (VAS give). The visual analogue scale score correlates well with acute pain.JOYCE, et alSuggested that visual analogue scale and another scales have been compared in terms of sensitivity, distribution of responses and preferences. Results of these studies appear equal. The visual analogue scale has been described as superior in one study because it was more sensitivity than any other scale.III. METHODOLOGY3.1 STUDY DESIGNPretest and Posttest Experimental group study design.3.2 STUDY SETTINGThe study was conducted at Department of Physiotherapy, K.G.Hospital, Coimbatore.3.3 STUDY DURATION3 weeks for each individual subject and the total durat ion was one year.3.4 STUDY POPULATIONPatients with Carpal tunnel syndrome referred to the Department of physiotherapy, K.G.Hospital, Coimbatore.3.5 STUDY SAMPLEAll patients with carpal tunnel syndrome who referred to Department of Physiotherapy, K.G. Hospital were selected. Among all patients, 20 patients who quenched inclusive and exclusive criteria were selected and assigned into two groups, 10 of each by using Purposive Sampling method.3.6 CRITERIA FOR SELECTIONINCLUSIVE CRITERIAAge group above 30 years.Both sexes.Patients with mild to moderate unilateral carpal tunnel syndrome.Patients with Positive Tinel sign, Phalens test and Digital compression test.EXCLUSIVE CRITERIAPatients with severe carpal tunnel syndromePatients having thenar atrophy or denervation on electromyographic findingsPatients with a neuropathy other than carpal tunnel syndrome in the past yearPatient with history of steroid injection in carpal tunnel in the past 3 monthsPatients had a prior carpal tunnel rel easeCervical disc prolapsedegenerative changes of cervical spineAcute upper limb fracturesWrist and fingers stiffnessRecent hand surgeriesDeqeurains diseasePregnancyAcute Infections of Wrist and Hand3.7 Variables strung-out variablePain.Independent variableVisual analogue scale.3.8 Orientation of subjectsBefore treatment all the patients were explained about the study and procedure to be applied and were asked to communicate if they feel any discomfort during the course of the treatment. All the willing patients were asked to sign the consent form before the treatment.3.9 OUTCOME MEASURESPain.3.10 OPERATIONAL TOOLSVisual analogue scale3.11 STUDY PROCEDURE20 Patients with carpal tunnel syndrome were selected for this study after due consideration of inclusive and exclusive criteria. 20 patients were divided into 2 groups of 10 each.Group A10 patients received ultrasound therapy, splint and exercises. Ultrasound therapy with parameters of 1 MHz pulsed mode, 14, 1 w/cm2 is given 15 mi nutes per day, five times per week. Custom made neutral volar splint is given at night and during day time. Exercises are nerve and tendon gliding exercises. During tendon-gliding exercises, the fingers are placed in five discrete positions. Those were straight, hook, fist, table top, and straight fist. During the median nerve-gliding exercise the median nerve was mobilized by set the hand and wrist in six different positions. During these exercises the neck and the shoulder were in a neutral position and the elbow was in supination and 90 degrees of flexion. for each one position was maintain for 5 seconds. Each exercise is repeated 10 times at each session, 5 sessions per day.The total treatment duration is 3 weeks.Group B10 patients received only Splint and Exercises.Custom made neutral volar splint is given at night and during day time. Exercises are nerve and tendon gliding exercises. During tendon-gliding exercises, the fingers are placed in five discrete positions. Those w ere straight, hook, fist, table top, and straight fist. During the median nerve-gliding exercise the median nerve was mobilized by putting the hand and wrist in six different positions. During these exercises the neck and the shoulder were in a neutral position and the elbow was in supination and 90 degrees of flexion. Each position was maintained for 5 seconds. Each exercise is repeated 10 times at each session, 5 sessions per day.The total treatment duration is 3 weeks.3.12 STATISTICAL TOOLSStatistical analysis was done using Student t-test.Paired t testWhere,n = Total number of subjectsSD = measuring rod deviationd = Difference between initial and final value= Mean difference between initial and final value.(ii) Unpairedt testTo compare the pre test, post test values of both groups independentt test is used.Where,n1 = Number of subjects in Group A.n2 = Number of subjects in Group B.= Mean of Group A= Mean of Group Bs1 = Standard deviation of Group A.s2 = Standard deviation of Gr oup B.S = Combined standard deviationIV.DATA ANALYSIS AND INTERPRETATIONTABLE-1VISUAL ANALOGUE SCALE FOR throe GROUP APAIREDt renderMean values, mean differences, standard deviation andt values of Visual Analogue Scale for Group A who underwent Ultrasound therapy, Splint, Nerve and Tendon gliding exercises.S. NOVASImprovementt valueMeanMean differenceStandard deviation1.Pre test5.603.900.7039.02.Post test1.700.67FIGURE-1GRAPHICAL REPRESENTATION OF MEANVISUAL ANALOGUE SCALE FOR GROUP ATABLE-2VISUAL ANALOGUE SCALE FOR PAIN FOR GROUP BPAIREDt TESTMean values, mean differences, standard deviation andt values of Visual Analogue Scale for Group B who underwent to Splint, Nerve and Tendon gliding exercises.S. NOVASImprovementt valueMeanMean differenceStandard deviation1.Pre test5.403.00.7020.122.Post test2.400.52FIGURE-2GRAPHICAL REPRESENTATION OF MEANVISUAL ANALOGUE SCALE FOR GROUP BTABLE-3VISUAL ANALOGUE SCALE FOR PAINPRETEST VALUES OF GROUP A VERSUS GROUP BUNPAIREDt TESTMean, mean di fference, standard deviation and unpairedt test of pre test v

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