Redefining Rehabilitation 0300Carpal Tunnel Syndrome (CTS) Medicare Splints Product Specifications And Technical Recommendation Note From MGRM Medicare Limited, Hyderabad 201, II Floor, Block A, Kushal Towers Khairatabad, Hyderabad – 500 004. Andhra Pradesh. INDIA Ph: +91 40 2339 6784 Fax: +91 40 6666 8551
PRODUCT SPECIFICATIONS CTS MEDICARE SPLINTSINTENDED USECTS MEDICARE SPLINTS ARE USED TO PROVIDE SUPPORT TO THE WRISTJOINT IN ORDER TO PREVENT HYPER-FLEXION MOVEMENTS OR REDUCEPAINFUL JOINT MOVEMENTS DURING DAY-TIME WORKS WHILE PROVIDINGCOMPLETE REST TO THE CTS-AFFECTED WRIST JOINT IN NEUTRALPOSITION DURING SLEEP HOURS. THE TYPES AND SIZES OF CTS MEDICARE SPLINTSS. PRODUCT PRODUCT SIZES UNIT Made of MaterialsNo. CODE NAME Qty1 0302 Carpal Tunnel Universal 1 Pc Al Splint, Elastic Band Splint2 0303 Solar Splint S, M, L, XL 1 Pc Nylon Loop, Elastic Band3 0304 Lunar Splint Universal 1 Pc Al Splint, Polyester PUFINDICATIONS FOR USE: • To reduce the incidence of carpal tunnel syndrome among Computer Staff, Hand Drillers, Carpenters, etc. • Wrist Pain and Numbness (Carpal Tunnel Syndrome) • Post-Operative Wrist Joint RehabilitationCOLORS AVAILABLE:Beige (Skin Color) and Navy BlueCAUTIONIndications for use are suggestive in nature.For specific use, medical advice is recommended.WASHING INSTRUCTIONSHand-Wash using cold water and mild soapDo not brush hard. Do not squeeze. No Machine-WashAir-dry in shade
0302 Carpal Tunnel Splint • Made of Skin-Friendly, Polyester Fabric Laminated PUF, Special Aluminum Alloy Splint and 3” width Polyester Elastic Tape • Easy product application using Nylon Hook and Loop Straps • Designed for use on either Right or Left Hand • Available in Universal Size for AdultsIndications for use Management of Carpal Tunnel Syndrome (CTS) by minimizing compression on the Median Nerve due to Hyper-Flexion movements of the Wrist. Prevention of CTS occurrence by reducing Repetitive Stress to the Wrist due to Hyper- Flexion.Fitting Instructions Insert thumb of the affected hand into the loop provided. With the fabric laminated foam side of the pad touching the hand, wrap the elastic band over the wrist joint. Position the foam pad over the middle of the dorsal side of wrist and use nylon hook and loop closure to fix the splint.
0303 Solar Splint Made of Elastic wrap with buckle and hook/loop strap closure enable easy product application and comfortable fit. Unique, adjustable NYLON loop covered with a soft flexible PVC tube for middle finger in order to control Volar Flexion movement of the wrist. Versatile Design allows self application. Designed for use on either Right or Left HandIndications for use Day-time wrist splinting for Carpal Tunnel (CT) Syndrome patients as a part of comprehensive treatment program Prevention of CT Syndrome occurrence.Fitting Instructions To form tubular opening, insert the nylon hook end of the elastic band into the buckle. Then, insert the affected hand into this opening and the middle finger into the loop provided. Pull the nylon hook on to the nylon loop for comfortable fit.Size Chart: Measure circumference of the affected wrist joint.
Size Label Small Medium Large X-LargeInches 5-6 6-7 7-8 8-9 9 - 100304 Lunar Splint Made of Skin-Friendly, Polyester Fabric Laminated PUF and special, light-weight Al Alloy splint to provide dorsal support with extraordinary comfort during sleep. This Night-Time Splinting limits involuntary hyper-flexion of the affected wrist splint during sleep or rest. Nylon hook & loop closures through buckles enable easy product application and proper fit. Designed to fit either left or right hand. Available in Universal Size for AdultsIndications for use Wrist Splinting for Carpal Tunnel (CT) Syndrome patients as a part of comprehensive treatment program during Rest or Night-time.Fitting Instructions Insert nylon hook and loop straps into the corresponding plastic buckles.
Insert the affected hand into the product by keeping the padded splint on backside (dorsal) of the hand. Tighten the straps of nylon hook and loop for secured and comfortable fit. TECHNICAL RECOMMENDATION NOTEIntroductionCarpal Tunnel Syndrome is a painful progressive condition caused by compression of theMedian Nerve in the Wrist (Carpal Tunnel).If you have been suffering from tingling or numbness in your hand and wrist for several months,you are probably suffering from CTS.About Carpal Tunnel Syndrome (CTS)Carpal tunnel syndrome (CTS) is a condition brought on by swelling and pressure inside a“tunnel” made up of bones (carpal bones) and a ligament (transverse carpal ligament) in yourwrist. Several tendons and the median nerve pass through the carpal tunnel. It is thecompression of the median nerve that causes the symptoms of CTS.Symptoms of Carpal Tunnel Syndrome (CTS) Pain, frequent tingling, or numbness in the fingers that can sometimes disturb sleep Cramping in the hand or wrist Feeling of fingers being swollen, although there is no swelling Weakness, with difficulty making a fist or squeezing objects in the hand
Symptoms of CTS may be variable and are often felt in the thumb, index, middle, and part of the ring finger. Area Supplied by the Median Nerve Transverse Carpal Ligament Carpal Tunnel Tendons and Tendon Sheaths Median Nerve CROSS SECTIONRisks for Carpal Tunnel Syndrome (CTS)People who type, work in manufacturing, use vibrating machinery, play sports involving handmovements, knit, or do any kind of repetitive motion involving the hand may be at risk ofdeveloping CTS. However, sometimes there is no definite cause, and there are many other riskfactors, including
• Arthritis or fracture near the wrist• Injury of the wrist causing swelling in the carpal tunnel• Pregnancy• Diabetes• Thyroid disease, particularly an underactive thyroidTreatment for Carpal Tunnel Syndrome (CTS)Treatment usually begins with a wrist splint to be worn mainly at night. Anti-inflammatory drugscan help relieve pain and numbness.Your doctor may also recommend a corticosteroid shot to help reduce swelling.It may be important to modify your workplace to ensure that your wrist stays in the neutralposition (wrist joint straight, not down) while you perform your job.If your CTS symptoms are severe or do not improve using the above treatments,Your doctor might recommend carpal tunnel release surgery to release pressure on the mediannerve. This surgery is usually performed through an incision in the wrist or palm. It may takeseveral months for strength in the hand and wrist to return to normal.Unfortunately, CTS may not go away completely after surgery in some cases.CTS - Prevention is Better than CureBecause many factors can contribute to carpal tunnel syndrome, there is no single mode ofprevention. Treating any underlying medical condition is certainly important. Simple commonsense may help minimize some risk factors predisposing a person to work-related CTS or othercumulative trauma disorders. A patient can learn how to adjust the work area, handle tools, orperform tasks in ways that put less stress on the hands and wrists. Proper posture and exerciseprograms to strengthen the fingers, hands, wrists, forearms, shoulders, and neck may helpprevent CTS.Corporate EffortsMany companies are now taking action to help prevent repetitive stress injuries. In a majorsurvey, 84% reported that they were modifying equipment, tasks, and processes. Nearly 85%were analyzing their workstations and jobs, and 79% were buying new equipment. It should bestressed, however, that there has been no evidence that any of these methods can providecomplete protection against CTS. The optimal corporate approach, if possible, is to reallocateworkers suffering from repetitive stress injuries to other jobs.Preventing CTS in Keyboard Workers
Altering the way a person performs repetitive activities may help prevent inflammation in thehand and wrist. Most of the interventions described below have been found to reduce repetitivemotion problems in the muscles and tendons of the hand and arm. They may reduce theincidence of carpal tunnel syndrome, although there is no definite proof of this effect.Replacing old tools with ergonomically designed new ones can be very helpful.Rest Periods and Avoiding Repetition. Anyone who does repetitive tasks should begin with ashort warm-up period, take frequent breaks, and avoid overexertion of the hand and fingermuscles whenever possible. Employers should be urged to vary the tasks and work content oftheir employees.Taking multiple "micro-breaks" (about 3 minutes each) reduces strain and discomfort withoutdecreasing productivity. Such breaks may include the following: • Shaking or stretching the limbs • Leaning back in the chair • Squeezing the shoulder blades together. • Taking deep breathsGood Posture. Good posture is extremely important in preventing carpal tunnel syndrome,particularly for typists and computer users. • The worker should sit with the spine against the back of the chair with the shoulders relaxed. • The elbows should rest along the sides of the body, with wrists straight. • The feet should be firmly on the floor or on a footrest. • Typing materials should be at eye level so that the neck does not bend over the work. • Keeping the neck flexible and head upright maintains circulation and nerve function to the arms and hands. One method for finding the correct head position is the "pigeon" movement. Keeping the chin level, glide the head slowly and gently forward and backward in small movements, avoiding neck discomfort.Good Office Furniture. Poorly designed office furniture is a major contributor to bad posture.Chairs should be adjustable for height, with a supportive backrest. Custom-designed chairs,made for people who do not fit in standard chairs, can be expensive. However, the costs are oftenoffset by the savings in medical expenses that follow injuries related to bad posture.Keyboard and Mouse Tips: Anyone using a keyboard and mouse has some options that mayhelp protect the hands. • The tension of the keys should be adjusted so they can be depressed without excessive force. • The hands and wrists should remain in a relaxed position to avoid excessive force on the keyboard.
• A 2003 study suggested that mouse-use poses a higher risk than keyboard use. Replacing the mouse with a trackball device and the standard keyboard with a jointed-type keyboard are helpful substitutions.• Wrist rests, which fit under most keyboards, can help keep the wrists and fingers in a comfortable position.• Some people recommend keeping the computer mouse as close to the keyboard and the users body as possible, to reduce shoulder muscle movement.• The mouse should be held lightly, with the wrist and forearm relaxed. New mouse supports are also available that relieve stress on the hand and support the wrist.• Some people cut their mouse pads in half to reduce movement.
What Medical Research says about Wearing Splints To Prevent or Reduce the Risk of CTS and for Post-Surgical Rehabilitation CareComparison of splinting, splinting plus local steroidinjection and open carpal tunnel release outcomes inidiopathic carpal tunnel syndrome.Ucan H, Yagci I, Yilmaz L, Yagmurlu F, Keskin D, Bodur H.Rheumatol Int. 2006 Nov;27(1):45-51. Epub 2006 Jul 27.Department of Physical Medicine and Rehabilitation, Ankara Numune Education and ResearchHospital, Ankara, Turkey. AbstractThe objective of this study was to compare the short- and long-term efficacies of splinting (S),splinting plus local steroid injection (SLSI), and open carpal tunnel release (OCTR) in mild ormoderate idiopathic carpal tunnel syndrome (CTS). Patients with mild or moderate idiopathicCTS who experienced symptoms for over 6 months were included in the study. The patientswere evaluated for the baseline and the third and sixth month scores after treatment. Follow-upcriteria were ENMG parameters, Boston Questionnaire, and patient satisfaction. Fifty-sevenhands completed the study. Twenty-three hands had been splinted for 3 months. Twenty-threehands were given a single steroid injection and splinted for 3 months, and 11 hands wereoperated. In the first 3 months, all treatment methods provided significant improvements in bothclinical and EMG parameters in which OCTR had better outcomes on median sensorial nervevelocity at palm wrist segment. In the second 3 months, while the clinical and EMG parametersbegan to deteriorate in S and SLSI group, OCTR group continued to improve, and BQ functionalcapacity score of OCTR group was statistically better than that in conservative methods (P =0.03). S and SLSI treatments improved clinical and EMG parameters comparable to OCTR inshort term. However, these beneficial effects were transient in the sixth month follow-up andOCTR was superior to conservative treatments.PMID: 16871409 [PubMed - indexed for MEDLINE]
Effects of wrist splinting for Carpal Tunnel syndromeand motor nerve conduction measurementsNobuta S, Sato K, Nakagawa T, Hatori M, Itoi E.Ups J Med Sci. 2008;113(2):181-92.Department of Orthopaedic Surgery, Tohoku Rosai Hospital, Sendai, Miyagi 981-8563 Japan.email@example.com AbstractBACKGROUND: Carpal tunnel syndrome (CTS) is one of the most common disease among theentrapment neuropathies. Wrist splinting has been conventionally used for the CTS treatment.The purposes of this study were to assess the efficacy of wrist splinting for CTS, and to evaluatethe value of the motor nerve conduction measurement as a prognostic indicator for CTS.METHODS: Two hundred and fourteen hands with CTS were treated by wrist splinting, andreviewed after a mean follow up of seven months. Severity of symptoms were minimal lesions in177 hands, intermediate lesions in 33 hands, and severe lesions in four hands. Motor nerveconduction measurement was performed in all cases before and after treatment, and distal latency(DL) and amplitude on compound muscle action potential (CMAP) from the abductor pollicisbrevis (APB) muscle were analyzed.RESULTS: According to Kellys grading of outcome, results were excellent in 41 hands, goodin 110 hands, fair in 45 hands, and poor in 18 hands. Excellent or good results were obtained in131 hands (74 percent) with minimal lesions, 20 hands (61 percent) with intermediate lesions,and in no cases with severe lesions. The ratio of excellent or good results was 79 percent inpatients in whom DL of pre-treatment APB-CMAP was less than 8 milliseconds (ms), and 62percent in patients whose DL was 8 ms or more, which showed a significant difference. In ninehands whose pre-treatment APB-CMAP was unrecordable, the results were good in one hand,fair in five, and poor in three.CONCLUSIONS: Wrist splinting is most effective in cases of minimal or intermediate lesionswith DL of APB-CMAP less than 8 ms. If relief of symptoms is not obtained after five months oftreatment by splinting, that would be the limit of splinting. Surgical release is recommended forcases with severe lesions and with unrecordable APB-CMAP.PMID: 18509812 [PubMed - indexed for MEDLINE]
Neutral wrist splinting in carpal tunnel syndrome:a comparison of night-only versus full-time wearinstructions.Walker WC, Metzler M, Cifu DX, Swartz Z.Arch Phys Med Rehabil. 2000 Apr;81(4):424-9.Department of Physical Medicine and Rehabilitation, Medical College of Virginia at VirginiaCommonwealth University, Richmond, USA.AbstractOBJECTIVE: To compare the effects of night-only to full-time splint wear instructions onsymptoms, function, and impairment in carpal tunnel syndrome (CTS).DESIGN: Randomized clinical trial with 6-week follow-up.SETTING: Veterans Administration Medical Center, outpatient clinic.SUBJECTS: Outpatients with untreated CTS were consecutively recruited from our electrodiagnostics lab. Twenty-one patients (30 hands) were enrolled, and 17 patients (24 hands)completed the study.INTERVENTIONS: Thermoplastic, custom-molded, neutral wrist splints with subjectsreceiving either full-time or night-only wear instructions.OUTCOME MEASURES: Symptoms and functional deficits were measured by Levines self-administered questionnaire, and physiologic impairment was measured by median nerve sensoryand motor distal latency. COMPLIANCE AND CROSSOVER: Almost all (92%) of thecombined sample reported frequent splint use, but their adherence to specific wearinginstructions was limited. A majority (73%) of the full-time group reported splint wear less thanone half of waking hours, and some (23%) of the night-only group reported occasional daytimewear. Despite this tendency for treatment crossover, the two treatment groups differed in daytimewear as intended (chi2 analysis, p = .004).RESULTS: The combined sample improved in three of four outcome measures: sensory distallatency (mean = .28msec, standard deviation [SD] = .37, p = .004), symptom severity (mean = .64, SD = .46, p = .0001), and functional deficits (mean = .49, SD = .51, p = .0001). Severity ofCTS was a factor only in sensory distal latency improvement (more improvement in severeCTS). Subjects receiving full-time wear instructions showed superior distal latencyimprovement, both motor (.35 vs -.07msec, p = .04) and sensory (.46 vs . 13msec, p = .05) whencompared with subjects receiving night-only wear instructions.
CONCLUSIONS: This study provides added scientific evidence to support the efficacy ofneutral wrist splints in CTS and suggests that physiologic improvement is best with full-timesplint wear instructions.PMID: 10768530 [PubMed - indexed for MEDLINE]Prevalence of carpal tunnel syndromein pregnant women.Ablove RH, Ablove TS.WMJ. 2009 Jul;108(4):194-6.University of Wisconsin School of Medicine and Public Health, Department of Orthopedics andRehabilitation, Madison, Wis, USA. firstname.lastname@example.org AbstractCarpal tunnel syndrome (CTS) is a frequent complication of pregnancy, with a prevalencereported as high as 62%. The most typical symptoms are numbness and tingling in the thumb,index finger, middle finger, and radial half of the ring finger. Other common manifestationsinclude burning dysesthetic wrist pain, as well as the loss of grip strength and dexterity. Proximalradiation along the volar forearm, medial arm, and shoulder, while not as common, is notunusual. Symptoms are often worse at night and can be exacerbated by forceful activity andextreme wrist positions. It can be diagnosed to a high degree of specificity via history andphysical examination. Median nerve function is impaired in virtually all pregnant women duringthe third trimester, even in the absence of symptoms. Treatment is symptomatic and usuallyconsists of activity modification, splinting, edema control, and, if necessary, steroid injections.While most women experience symptomatic improvement following delivery, a significantpercentage may still have some complaints up to at least 3 years post-partum and continue towear splints. A high level of vigilance should be maintained in the management of these patients.PMID: 19753825 [PubMed - indexed for MEDLINE]
Systematic Reviews of Treatments for CTSCarpal Tunnel Syndrome Part I:Effectiveness of Non-Surgical Treatments - ASystematic Review.Huisstede BM, Hoogvliet P, Randsdorp MS, Glerum S, van Middelkoop M, Koes BW.Arch Phys Med Rehabil. 2010 Jul; 91 (7):981-1004.Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands.email@example.com AbstractOBJECTIVE: To review literature systematically concerning effectiveness of nonsurgicalinterventions for treating carpal tunnel syndrome (CTS).DATA SOURCES: The Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro weresearched for relevant systematic reviews and randomized controlled trials (RCTs).STUDY SELECTION: Two reviewers independently applied the inclusion criteria to selectpotential studies.DATA EXTRACTION: Two reviewers independently extracted the data and assessed themethodologic quality.DATA SYNTHESIS: A best-evidence synthesis was performed to summarize the results of theincluded studies. Two reviews and 20 RCTs were included. Strong and moderate evidence wasfound for the effectiveness of oral steroids, steroid injections, ultrasound, electromagnetic fieldtherapy, nocturnal splinting, and the use of ergonomic keyboards compared with a standardkeyboard, and traditional cupping versus heat pads in the short term. Also, moderate evidencewas found for ultrasound in the midterm. With the exception of oral and steroid injections, nolong-term results were reported for any of these treatments. No evidence was found for theeffectiveness of oral steroids in long term. Moreover, although higher doses of steroid injectionsseem to be more effective in the midterm, the benefits of steroids injections were not maintainedin the long term. For all other nonsurgical interventions studied, only limited or no evidence wasfound.
CONCLUSIONS: The reviewed evidence supports that a number of nonsurgical interventionsbenefit CTS in the short term, but there is sparse evidence on the midterm and long-termeffectiveness of these interventions. Therefore, future studies should concentrate not only onshort-term but also on midterm and long-term results.Copyright 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. Allrights reserved.PMID: 20599038 [PubMed - indexed for MEDLINE]Carpal Tunnel Syndrome Part II:Effectiveness of Surgical Treatments- A Systematic Review.Huisstede BM, Randsdorp MS, Coert JH, Glerum S, van Middelkoop M, Koes BW.Arch Phys Med Rehabil. 2010 Jul;91(7):1005-24.Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands.firstname.lastname@example.org AbstractOBJECTIVE: To present an evidence-based overview of the effectiveness of surgical andpostsurgical interventions to treat carpal tunnel syndrome (CTS).DATA SOURCES: The Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro weresearched for relevant systematic reviews and randomized controlled trials (RCTs).STUDY SELECTION: Two reviewers independently applied the inclusion criteria to selectpotential studies.DATA EXTRACTION: Two reviewers independently extracted the data and assessed themethodologic quality.DATA SYNTHESIS: A best-evidence synthesis was performed to summarize the results of theincluded studies. Two reviews and 25 RCTs were included. Moderate evidence was found infavor of surgical treatment compared with splinting or anti-inflammatory drugs plus handtherapy in the midterm and long term, and for the effectiveness of corticosteroid irrigation of themedian nerve before skin closure as additive to carpal tunnel release in the short term. Limitedevidence was found in favor of a double-incision technique compared with the standard incision
technique. Also, limited evidence was found in favor of a mini-open technique assisted by aKnifelight instrument compared with a standard open release at 19 months of follow-up.However, in the short term and at 30 months of follow-up, no significant differences were foundbetween the mini-open technique assisted by a Knifelight instrument compared with a standardopen release. Many studies compared different surgical interventions, but no evidence was foundin favor of any one of them. No RCTs explored the optimal timing strategy for surgery. Noevidence was found for the efficacy of various presurgical or postsurgical treatment programs,including splinting.CONCLUSIONS: Surgical treatment seems to be more effective than splinting or anti-inflammatory drugs plus hand therapy in the midterm and long term to treat CTS. However,there is no unequivocal evidence that suggests one surgical treatment is more effective than theother. More research is needed to study conservative to surgical treatment in which also shouldbe taken into account the optimal timing of surgery. Future research should also concentrate onoptimal pre-surgical and post-surgical treatment programs.Copyright 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. Allrights reserved.PMID: 20599039 [PubMed - indexed for MEDLINE] Why MGRM Medicare CTS Splints?Product Quality are of International Standards"CE" Certifiedwhich consisting of ISO 14971, EN1441 & EN980 and conforms to therequirements of "Medical Devices Directive 93/42/EEC" (for Europe market).Registered with FDA (Food and Drug Administration) of the USA (for USMarket)Quality of Company-wide Processes for Design, Development, Manufacturingand Marketing are being Assured by the ISOStandards – IS0 9001:2008 and ISO 13485:2003.Environmental and Occupational Health & Safety Management are beingPlanned, Implemented, Monitored and Controlled by the ISO Standards – ISO14001:2004 and OHSAS 18001:2007.
Redefining Rehabilitation“Search and research are the essence of mankind. The resultantawareness leads to an individual’s physical, psychological, social andspiritual evolution. Extensive scientific and medical research hasproved that the concept of rehabilitation is not limited to physicalrehabilitation. Ultimate rehabilitation for the human race is one thatcan recognize and simultaneously encompass all the above elementsthat make an individual, a complete personality. “ Dr . K. V. R. Mur thy Founder MGRM MGRM Medicare Limited 201, II Floor, Block A, Kushal Towers Khairatabad, Hyderabad – 500 004. Andhra Pradesh. INDIA Ph: +91 40 2339 6784 Fax: +91 40 6666 8551 www.mgrm.com email@example.com