Degrees Of Carpal Tunnel Syndrome Health And Social Care Essay

Degrees Of carpus bone b nonp aril bone cut into Syndrome Health And Social C atomic number 18 essay radio wrist bone joint bone bone cut into syndrome is a al most(preno momental) common densification neuropathy of the pep pill extremity. It is managed by coalescency of medial(prenominal)(prenominal) font in the wrist critical point bone cut into.Women are much commonly affected than men. It is commonly seen in age conclave between 30 and 60 years. wrist bone delve syndrome usu all toldy occurs delinquent to excessive use of the rolls and occupational exposure to repeated detriment. bonny cross sectional area of the wrist bone dig is 1.7 cm2 with the wrist in achromatic fix. Passive prosody and ex strain of the wrist has been increased the wrist bone turn over bosom. Wrist addition increases wrist bone cut into obligate much(prenominal) than the wrist plication. Any space occupying mass or swelling of the structures in the cut into too ca uses pressure on the median(prenominal) spunk.Mostly, the cause of carpal delve syndrome is unknown. Any condition which causes pressure on median hardiness at the wrist ordain chair in carpal cut into syndrome. Obesity, pregnancy, hypothyroidism, arthritis, diabetes and trauma are the common conditions that lead to carpal cut into syndrome. crying work such(prenominal) as uninterrupted typing which result in muscle dismissal plenty excessively cause carpal cut into symptoms. Carpal dig syndrome due to repetitive activities has referred to one of the repetitive evince injuries. In about rare diseases such as amyloidosis, leukemia, multiple myeloma, and sarcoidosis, alluviation of ab natural substances in and around the carpal tunnel leads to poise irritation. draw out flexion or lengthiness of the wrists under the patients head or remain du resile sleep is believed to contribute to the prevalence of nocturnal symptoms. Usually patient complaints vexation, impas sivity and tingling sensation in the feed and fingers. Symptoms worsening at wickedness typically awakening the patient or occurring on bunching up the hand for tasks such as writing.Carpal tunnel syndrome is the most common cause of acroparaesthesiae very much pain and paraesthesiae may be the only symptoms for many months or years. The syndrome is essentially a sensory one the loss or evil of superficial sensation affects the thumb, index number and middledle fingers and may be or may not split the ring finger. on that point may be wasting and suspensorlessness of the thenar muscles. Weakness and atrophy of the abductor pollicis brevis and early(a) muscles supplied by median hardihood occur in only the most advanced cases of concretion.Degrees of carpal tunnel syndrome are classified as dynamic, barmy, command and severe. The pathophysiology of carpal tunnel syndrome is typically demyelination. Secondary axon loss may present in to a greater extent severe cases. Wit h 20 to 30 mm hg compression, the initial insult is a reduction in epi spooky melody flow. With wrist extension, intracarpal pressures routinely measure atleast 33 mm hg and often upto 110 mm hg in patients with carpal tunnel syndrome. oedema in the epineurium and endoneurium is ca utilize by continued or increased pressure.Carpal tunnel syndrome diagnosed by detailed history collection, phalen maneuver, percussion sample, two point disagreement analyse, vibrometry, monofilament test, distal sensory reaction time and conduction velocity, distal force latency conduction, upper limb tension tests. X-ray is taken to check for arthritis and fracture. If in that location is a suspected medical condition that is associated with carpal tunnel syndrome, research laboratory tests may be done.This condition could be mistaken for a brachial neuritis due to cervical intervertebral disc prolapse at C5 C7 level. administration conduction tests on the median marrow help to localize the lesion in the tunnel.Both bourgeois and surgical prudence options are available in order to geld pressure over median affection. The current conservative interventions include non steroidal anti inflammatory drugs, roughlytimes rest, local shaft of corticosteroids, natural action modification, echography therapy, carpal bone mobilization, magnetic therapy, wickedness and/or twenty-four hour periodtime wrist splint positioned at 0 to 15 degrees of extension, side and tendon move behaves. Anyone of the measures totally or in combination can be consequenceive in treating early carpal tunnel syndrome. brawniness gliding exercises are performed to lubricate and increase gliding of the flexor muscle muscle pollicis longus, flexor digitorum superficialis and flexor digitorum profundus tendons. They are best performed with the hand reversed to concurrently authorization local edema. Median nerve gliding exercises and the upper limb tension test with median nerve bias can be use as intercession techniques.Modality treatment can also supremacy symptoms and enhance the therapeutic exercise program.Exercise intervention for carpal tunnel syndrome focuses on mobility and military unitening without producing an exacerbation. Stretches for the extrinsic and intrinsic muscles are prescribed for some(prenominal) times severally sidereal suppose solar day. If working, a patient should perform them before work. They should be performed slowly and gently the patient feel only a slake stretching sensation. In workplace, modification of the job site or lie with ergonomic rede scratch is typically the most helpful approach. In do-gooder yoga, chiropractics, optical maser treatment have been advocated.Surgery is indicated in advanced cases with object lens sensory loss and /or weakness or atrophy of the abductor pollicis brevis. In severe cases surgical division of the transverse carpal ligament relieves the condition. surgical watchfulness includes open carpal tunnel release and endoscopic release. It aims to slack nerve, to improve excursion and to prevent flexor damage. treating is the most popular system of conservative management of carpal tunnel syndrome. care fors are urge oned by the American Academy of Neurology for the Carpal tunnel syndrome with debile and take hold pathology. immobilizing of the wrist joint in a deaf(p) position with splint exit increase the carpal tunnel volume and minimize the median nerve pressure. Wrist care foring in a neutral position volition help reduce and may even totally relieve Carpal tunnel syndrome (Slater RR et al 1999). ultrasonography therapy is more serviceable in the management of Carpal tunnel syndrome. It has the potential to accelerate normal resolution of inflammation. sonography therapy elicit anti inflammatory and tissue stimulating effects. ultrasound therapy accelerates the mend process in damaged tissues.Pulsed ultrasonography therapy with the intensity of 1.0 w/cm2, 14 for fifteen minutes per session has strongly improved inhering 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 pass devotions and to regulate venous return in nerve bundles (Rozmaryn et al).Nerve and tendon gliding exercises may maximize the relation back drive of the median nerve within the Carpal tunnel and the excursion of flexor tendon congeneric to one another (Rempel D, Manojlovic R et al).Wrist splint along with nerve and tendon gliding exercises showed authoritative improvement in trim down symptoms in Carpal tunnel syndrome. (Akalin et al)NEED FOR THE hit the booksUltra sound therapy, splints, nerve and tendon gliding exercises are significantly rough-and-ready in reducing symptoms in the treatment of Carpal tunnel syndrome. Combination of various treatments is also useful in reducing symptoms in Carpal tunnel syndrome. Ultraso und therapy helps to increase healing process in damaged tissue.This consider aimed to let on out the effect of Ultrasound therapy in reducing pain in patients with Carpal tunnel syndrome.STATEMENT OF THE PROBLEMEffect of Ultrasound Therapy in reducing pain in patients with Carpal tunnel syndrome.KEY courseCarpal tunnel syndromeUltrasound therapySplintExercises annoying optic parallel of latitude home ( vas)AIMTo find out the Effect of Ultrasound Therapy in reducing pain in patients with Carpal Tunnel Syndrome.OBJECTIVETo acquire the Effect of Ultrasound Therapy in reducing pain in patients with Carpal Tunnel Syndrome.HYPOTHESIS1.6.1. NULL HYPOTHESIS on that point 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, Spl int 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 Exercises 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) verbalise 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 various degrees of local and systemic factors. Symptoms of carpal tunnel syndrome are due to ischemia an d impaired axonal transport of the median nerve which results from median nerve compression at the wrist. (Lunborg G, Dahlin LB 1992). distinguished pressure inside the carpal tunnel leads to compression.HARVEY SIMON, MD et al, (2009) stated that carpal tunnel syndrome is considered as an inflammatory disorder caused by medical conditions, physical injury or repetitive stress.JEFFREY G NORVELL, MD et al (2009)declared 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 remove physical damage of the nerve.S.BRENT BROTZMAN, MD (2003)Explained that degree of the carpal tunnel syndrome as dynamic, dotty moderate and severe. In mild cases, patients has intermittent symptoms, decreased light touch, arbitrary digital compression test and positive tinel sign or phalen test may or may not be present. In moderate cases, pati ents have 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) express that carpal tunnel syndrome (CTS) is caused by median nerve compression at the wrist and is considered to be the more common 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 Pour 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 produce 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 nerv e is reduced by pressure as low as xx to xxx 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 sextetty to cardinal 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 slopped pressure was 32 millimeters of mercury. With ninety degrees of wrist flexion the pressure rai sed 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 millimeters 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 do 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 outright 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 u sually 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 nerve 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 uninter rupted 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 maximal 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 reason out that wrist of patients with Carpal tunnel syndrome showed less skid which indicates that physiological motion of the nerve is restricted. This decrease in nerve mobility may be of significance in the pathophysiology 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 proveed and allocated randomly in two companys. One base reliable low level laser therapy and the other stem receive 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 precondition 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 clear strength, and pain reduction. Effects were also sustained in the follow-up period. They concluded that ultrasound therapy was more effective than laser 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 apply over the carpal tunnel and compared with Sham Ultrasound. Actively treated 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. surplus randomized trials comparing conservative therapies for Carpal tun nel 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 1990). 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 reserve, increased grip and pinch strength, and changed electrophysiological parameters toward normal set better than laser therapy.WRIST SPLINTWrist splints help to keep the wrist true 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 information team 2010)BRININGER TL, ROGERS JC et al (2007)Fabricated customized neutral splint and nerve and tendon 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 acting 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 scale and symptom severity scale. They also reported 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 intentional 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 provender 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 demonstrate 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 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 employ 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. all 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 intermittent 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 included 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 property 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 elongate 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 dandy pain measurement as assessed by the intraclass correlation coefficients (ICC) appears to be high. The results showed that the Visual analogue scale (VAS) is sufficiently reliable to be used to assess acute pain.PAUL 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 odd edge (VAS score). 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 aesthesia, distribution of responses and preferences. Results of these studies appear equal. The visual analogue scale has been expound as superior in one study because it was more sensitivity than any other scale.III. METHODOLOGY3.1 ruminate 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 succession 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 satisfied 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 tunne l syndromePatients having thenar atrophy or denervation on electromyographic findingsPatients with a neuropathy other than carpal tunnel syndrome in the past times yearPatient with history of steroid injection in carpal tunnel in the past 3 monthsPatients had a prior carpal tunnel releaseCervical disc prolapseDegenerative changes of cervical spineAcute upper limb fracturesWrist and fingers stiffness new-make hand surgeriesDeqeurains diseasePregnancyAcute Infections of Wrist and Hand3.7 Variables dependant variablePain.Independent variableVisual analogue scale.3.8 Orientation of subjects ahead treatment all the patients were explained about the study and procedure to be applied and were asked to inform if they feel any discomfort during the course of the treatment. All the uncoerced 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 sele cted for this study after due consideration of inclusive and exclusive criteria. 20 patients were divided into 2 groups of 10 each. gathering A10 patients received ultrasound therapy, splint and exercises. Ultrasound therapy with parameters of 1 MHz pulsed mode, 14, 1 w/cm2 is given 15 minutes per day, five times per week. impost 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 lay 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 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 maintain for 5 seconds. Each exercise is repeated 10 times at each session, 5 sessions per day.The total treatment durati on is 3 weeks. root word 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 were 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 = exemplification divergenced = passing 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 concourse 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 Group B.S = Combined standard deviationIV.DATA ANALYSIS AND INTERPRETATIONTABLE-1VISUAL linear SCALE FOR PAIN GROUP APAIREDt examinationMean 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. NOVAS receiptst valueMeanMean differenceStandard deviation1.Pre test5.603.900.7039.02.Post test1.700.67FIGURE-1GRAPHICAL REPRESENTATION OF look onVISUAL 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 glidin g 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 difference, standard deviation and unpairedt test of pre test v