Palpatory diagnosis and manipulative management of carpal tunnel syndrome

Abstract

Carpal tunnel syndrome was studied by use of supplemental palpatory diagnosis in 20 abnormal wrists. Restriction in motion at the carpal tunnel was quantified with a rating system. All wrists with carpal tunnel syndrome revealed at least moderate restriction to motion, as compared with only mild or no restriction in 20 wrists in normal, symptom-free subjects. Several participants (16 abnormal wrists) underwent osteopathic manipulative treatment, including a new "opponens roll" maneuver, and self-stretching, or a similar treatment accomplished by use of a self-treatment appliance. In those treated, palpatory restriction decreased into the normal range, often before symptoms decreased. Improvement in nerve conduction studies usually followed within 1 to 3 months. Palpatory diagnosis is a useful adjunctive method of assessing patient status in carpal tunnel syndrome and helpful in prognosticating outcome. The modified manipulative technique described for the treatment of mild to moderate carpal tunnel syndrome may be effective in more severe cases.

Ultrasound imaging of the carpal tunnel during median nerve compression

“…The performance of prehensile hand movement requires that the primary movers of the thumb (abductor pollicis brevis and opponens pollicis) are fixated at their base of attachment where they “anchor” to the transverse carpal ligament (TCL) [9, 10]. Fixation at the base allows muscle contraction to pull the thumb towards the other digits to generate maneuvers for controlled grasping.…”

“…It may be that fibrosis within the carpal canal of CTS patients prevents the MN from sliding out of harms way during routine hand activity. In fact, Sucher suggested that manipulation and stretching may be successful in alleviating symptoms of CTS by breaking up the adhesions or fibrous fixations [10]. …”

“…Researchers have observed contractile cells in the TCLs of CTS patients and suggested that they were undergoing a constant state of contraction [15]. Sucher [10] observed and quantified mechanical restriction at the wrist in CTS patients, which could correlate with tightness in the TCL. Subsequent work by Sucher and Hinrichs [16] identified that the distal band of the TCL is the most significant, because it is thicker, and thus correlates with this region being the site of maximal nerve conduction slowing and maximal nerve compression seen on NMUS.…”

“…Studies [10, 16–19] have demonstrated osteopathic manipulative treatment (OMT) of the wrist can increase the size of the CT, alleviate CTS symptoms, and lead to improved nerve conduction values. The most essential technique used for OMT of CTS involves thenar abduction and extension, which applies traction to the TCL, most likely elongating the TCL and increasing space within the CT. Another effect of the OMT that was not previously considered probably involves elongation of the thenar muscles and release of the focal prominence that intrudes into the tunnel during active contraction.…”

Differential diagnosis of atypical focal peripheral neuropathy: Case report

“…Two studies that used joint mobilization suggest moderate benefits in range of motion and a reduction of pain versus those who received no treatment (Akalin et al, 2002;Manente et al, 1999). Some evidence infers that manipulation and myofascial stretching may lengthen the flexor retinaculum, but these studies were performed on cadaveric tissue and extrapolation may be inappropriate (Sucher, 1994;Sucher and Hinrichs, 1998). Low-quality evidence supports the use of nerve-gliding 238 Cook and Goode/Physiotherapy Theory and Practice 23 (2007) 231À241 Physiother Theory Pract Downloaded from informahealthcare.com by Central Michigan University on 11/19/14 mobilization exercises (Akalin et al, 2002;Tal-Akabi and Rushton, 2000).…”