Osteopathic Approach to the Patient with Carpal Tunnel Syndrome

Posted by e-Medical PPT Tuesday, October 30, 2012
Symptoms and Signs
Thumb, index, middle, and radial aspect of ring finger
Hand Pain
Pins and Needles
Nocturnal Paresthesia
Thenar weakness/atrophy
Diminished vibratory sensation/2 point discrimination
Weak grip with thumb
Phalen’s sign
Tinel’s sign

Treatment Overview
Mild and moderate cases :
nocturnal and or daytime splints
evaluation and manipulation to relieve dysfunctions
frequent self stretch
injection if no better with splints (steroid)
into the space of the canal, not the nerve or tendon

Severe cases: thenar atrophy, worsening rather than improving, or no improvement over 6 weeks:
surgical referral
Surgical section may increase carpal arch by only 2-3mm in the transverse dimension
Cadaver studies show transverse lengthening (as a result of manipulation or loading with weights) 1-3mm
Palpatory evaluation will elicit areas of functional constriction other than the carpal tunnel

Manipulative Highlights
transverse carpal ligament has visco-elastic properties: manipulation and stretching can actually increase the size of the canal
opponens pollicis roll directly elevates the transverse carpal ligament off the median nerve: muscles blend into the flexor retinaculum
guy-wire technique uses flexor digiotorum profundus and flexor pollicis longus to gap the tunnel
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