Case Study: Carpal Tunnel Syndrome

General Information

The client is a 34-year-old chef who was originally referred with a left arm and wrist strain sustained whilst carrying a heavy bucket at work. The client originally described their symptoms as ‘similar to an electric shock in the neck’ before noticing that the symptoms moved down into the left forearm and thumb on the radial side.

Range of motion tests at the initial assessment showed full movement of the shoulder, elbow and wrist with some restrictions through cervical flexion and extension. The client had some major concerns specifically how the pain was aggravated by activity and the impact that the injury was having on all aspects of their life including their mental health. The client was at a stage with the injury that they were contemplating a change in career, away from their passion of cooking, and potentially traveling back to their home country due to the visa requirements surrounding employment.

Over the course of the claim the client attended several chiropractic appointments involving acupuncture and spinal manipulation, but this ceased due to providing limited relief. The client also attended a specialist physiotherapist who recommended addressing nerve desensitization, neck posture, and upper limb strength and was prescribed several self-management exercises. The client was placed on a lifting restriction of 3kgs, modified duties and reduced hours as part of their return to work programme. After several weeks of ongoing treatment, the client was referred for a nerve conduction study with the specialist diagnosing the client with moderate carpal tunnel syndrome.

 Job Specific Programme

The client’s core work tasks involve preparing ingredients, cooking and washing dishes. These tasks involve hand grip strength, fine dexterity while handling and chopping ingredients, frequent carrying of pots between benches and stoves weighing up to 18kgs.

The exercise rehabilitation programme initially focused on several upper body range of motion and muscle release exercises. The client progressed to functional upper body strengthening exercises combined with the correct manual handling technique necessary for the job role to reduce the risk of re-injury. Below is an example of one the work specific exercises prescribed in the end stages of the exercise programme, and this was done to replicate a core task of the job role.

Farmers Carry

As part of the client’s return to work plan, they gradually increased their lifting restrictions and hours. A job site assessment was also done, and several techniques and options were implemented to assist with their regular duties. This approach ensured a safe return to their pre-injury role by gradually building up their functional capacity and work tolerance.

 

 

 

Outcome of Exercise Rehabilitation

The client is now at 100% functional capacity and is completing the exercise programme independently three times per week. The client showed significant improvements in pain-free range of motion through the neck, shoulder, forearm and wrist. The client was provided with all the tools to self-manage their programme and has been educated on the importance of pre and post work stretching. The client has reached all outcome measures set by Absolute Balance and is currently performing their pre-injury duties and hours. Prior to the injury the client did not exercise and is now currently attending the Gym 5 days per week and has made it a part of their daily routine.  The client can now continue with their passion of cooking and through the process has uncovered another passion, Exercise.

For more information on return to work exercise rehabilitation programmes contact Absolute Balance on 9244 5580 or email us at info@absolutebalance.com.au.

Michael Buswell (B.Sc. –  Exercise Physiology)
Accredited Exercise Physiologist (AEP) (ESSAM)