Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) can affect just
about everyone, but particularly people involved in occupations
requiring repetitive use of the hands and wrists (i.e., office
and skilled labor jobs). Medical doctors commonly prescribe
anti-inflammatory drugs, which prove ineffective in some
patients and cause adverse side effects in others.
The double
crush syndrome is a compression neuropathy of two areas,
one usually distant from the other. A growing number of researchers
have suggested a correlation between some peripheral neuropathies,
of which carpal tunnel syndrome is one and cervical nerve
root compression another. The nerve is “crushed” or irritated in the spine, “priming” more
distal areas of the nerve for dysfunction when that part
is stressed (second “crush”).
Autonomic dysfunction
in idiopathic carpal tunnel syndrome Verghese J, Galanopoulou
AS, Herskovitz S, Muscle Nerve 2000 Aug;23(8):1209-13
This is
the study of 76 patients with CTS (in 139 limbs). Autonomic
symptoms were reported in 76 limbs (47 patients). Of these,
59% consisted of swelling of the fingers, 39% dry palms, 33%
Raynaud's phenomenon, and 32% blanching of the hand. Sympathetic
skin response (SSR) had a sensitivity/specificity ratio of
34/89% in CTS with autonomic symptoms. The presence of autonomic
disturbances was significantly associated with female gender
but not age, duration of disease, or clinical severity in a
binary logistic regression model.
It appears that autonomic
disturbances are common (55%) in CTS, occurring with increasing
severity of electrophysiologic findings.
Conservative chiropractic
care of cervicobrachialgia Glick DM, Chiropr Res J, 1989; 1(3):49-52
Cervicobrachialgia,
also known as “brachial neuritis” or “brachial
neuralgia” involves neck and arm pain that can be described
as “sharp,” “stabbing,” or “aching,” with
acute sudden onset. The pain is in the shoulder blade, the
side of the neck and may continue through the upper arm.
This
is the case of a 42 year-old woman diagnosed with the above
condition who had suffered a fall skiing during the prior
week when symptoms began. Upper cervical x-rays revealed
the atlas to be displaced laterally to the right and rotated
anterior on that side. The patient was adjusted upper cervically
by hand.
Immediately following the first adjustment the patient
reported noticeable relief in symptoms. 48 hours later she
received a second adjustment. Three days later she was checked
again and did not need an adjustment.
Comparative efficacy of
conservative medical and chiropractic treatments for carpal
tunnel syndrome: a randomized clinical trial. Davis PT, Hulbert
JR, Kassak KM, et al. Journal of Manipulative and Physiological
Therapeutics, June 1998, vol.21/no.5, pp317-26.
This study showed
that chiropractic was as effective as medical treatment in
reducing symptoms of CTS. Chiropractic care included spinal
adjustments, and in addition, ultrasound over the carpal tunnel
and the use of nighttime wrist supports.
Clinical commentary:
pathogenesis of cumulative trauma disorders. MacKinnon S. Journal
of Hand Surgery, Sept. 1994, 873-883.
In a study of 64 patients
with repetitive stress disorders of whom 34 had wrist surgery,
wrist pain or discomfort was not the only symptom the patients
complained of.
Most patients had multiple problems, especially
muscle imbalance. The high failure rate of surgery causes the
author to rethink the cause of CTS: “Unnatural postures
for extended periods creating pressure on the nerves in the
neck, leading to neurological and other symptoms...even when
extremity surgery improves the peripheral symptoms such as
numbness in the hands, other associated problems like neck
stiffness and shoulder pain persist.”
The double crush
in nerve entrapment syndromes. Upton, ARM, McComas AJ. Lancet
2:329, 1973.
67% to 75% of patients who had carpal tunnel syndrome
or ulnar neuropathy also had spine nerve root irritation.
Impaired
axoplasmic transport and the double crush syndrome: food for
chiropractic thought. Czaplak S, Clinical Chiropractic Jan.
1993 p.8-9.
The author writes: “Chiropractic has an extensive
anecdotal history of patients being relieved of classic carpal
tunnel symptoms with spinal adjustments and/or cervical tractioning
only.”
Carpal tunnel syndrome as an expression of muscular
dysfunction in the neck. Skubick DL, Clasby R, Donaldson CCS
et al. J Occup Rehabil 3:31-44, 1993.
In this study of 18 patients
it was concluded that carpal tunnel syndrome can occur from
increased forearm flexor activity caused by muscle dysfunction
in the neck.
Double crush syndrome: what is the evidence? Swenson
RS. J Neuromusculoskeletal System, Spring 1993; 1(1): 23-29.
The
authors hypothesize that a nerve injury close to the spine
may weaken peripheral nerves.
Surgery of the peripheral nerve.
MacKinnon SE, Dellon AL. Thieme Medical Publishers. New York,
1988.
Nerve compression near the spine is found
in people with carpal tunnel syndrome
Double crush syndrome:
cervical radiculopathy and carpal tunnel syndrome. Osterman
AL, Pfeffer G, Chu J, et al. Presented at the 41st annual American
Society for Surgery of the Hand, New Orleans, LA 1986. Describes
the double crush syndrome in detail.
The double lesion neuropathy:
an experimental study and clinical cases. Nemoto et al Abstract
123, Second Int’l
Congress. Boston, MA Oct. 1983.
Cervical nerve compression can
block the distribution of necessary cellular material to the
distal nerve axon such as in the wrist, making it more susceptible
to injury.
The relationship of the double crush syndrome (an
analysis of 1,000 cases of carpal tunnel syndrome). Hurst LC,
Weissberg D, Carroll RE. J Hand Surg 10B: 202, 1985.
A significant
correlation was found between bilateral carpal tunnel syndrome
and radiologically diagnosed cervical arthritis.
Double crush
syndrome: a chiropractic/surgical approach to treatment. Cramer
SR, Cramer LM Dig of Chiropractic Economics Mar/April, 1991.
Seventy
five patients received chiropractic and hand surgery/rehabilitation.
It was concluded that these two approaches are complementary
and can be effective in improving the lives and prognoses
of patients.
Carpal tunnel syndrome: a case report. Ferezy,
JS, Norlin, WT. Chiropractic Technique, Jan/Feb 1989 P.19-22.
Electromyelography
demonstrated objective improvement in this case of CTS following
chiropractic care.
Research finds surface EMG useful in treatment
of CTS. Prosanti MP. Advances For Physical Therapists, July
6, 1992.
Muscles of the neck could be involved in problems within
the arm and wrist and has been a subject of discussion for
several years.
A treatment for carpal tunnel syndrome:
evaluation of objective and subjective measures. Bonebrake
AR, Fernandez JE, Marley RJ et al. Journal of Manipulative
and Physiological Therapeutics, Vol.13 No.9 Nov/Dec 1990.
Thirty
eight CTS sufferers underwent spinal manipulation and extremity
adjusting, soft tissue manipulation, dietary changes and daily
exercises. Post treatment results showed improvement in all
strength and range of motion measures. A significant reduction
of nearly 15% in pain and distress ratings was documented.
Resolution
of a double-crush syndrome. Flatt DW. Journal of Manipulative
and Physiological Therapeutics, July/August 1994; 17(6): 395-397.
A
63-year-old man suffered from a 36-month history of right anterior
leg numbness and recurrent lower back pain. Complete resolution
of right anterior leg numbness followed chiropractic. Although
not a carpal tunnel problem, the double crush phenomenon, in
this case involving the leg, and its resolution under chiropractic
care is of interest.
Spinal Manipulation, 5th edition by Bourdillon
JE, Day EA, Bookhout MR: Oxford, England, Butterworth-Heinemann
Ltd, 1992:
“Faulty innervation caused by spinal joint lesions
is one of the main factors in the production of carpal tunnel
syndrome.” p. 207.
Double crush syndrome: chiropractic
care of an entrapment neuropathy. Mariano KA; McDougle MA;
Tanksley GW. Journal of Manipulative and Physiological Therapeutics,1991
May, 14(4): 262-5.
Discusses the relationship between double
crush syndrome and chiropractic care.
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Inc. & Tedd Koren,
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