Manipulative Physiol Ther. 1999 Jun;22(5):348-9.
Comparative efficacy of conservative medical and chiropractic treatments
for carpal tunnel syndrome: a randomized clinical trail.
Davis PT, Hulbert JR, Kassak KM, Meyer JJ.
Northwestern College of Chiropractic, Bloomington, MN 55431, USA.
OBJECTIVE: To compare the efficacy of conservative medical care with
chiropractic care in the treatment of carpal tunnel syndrome. DESIGN:
Two-group, randomized, single-blind trial with 9 wk of treatment and a
1-month follow-up interview. SETTING: Wolfe-Harris Center for Clinical
Studies at Northwestern College of Chiropractic in Bloomington, Minnesota.
PATIENTS: Ninety-one of 96 eligible subjects who reported symptoms that
were confirmed by clinical exam and nerve conduction studies.
INTERVENTIONS: Interventions included ibuprofen (800 mg 3 times a day for 1
wk, 800 mg twice a day for 1 wk and 800 mg as needed to a maximum daily
dose of 2400 mg for 7 wk) and nocturnal wrist supports for medical
treatment. Chiropractic treatment included manipulation of the soft tissues
and bony joints of the upper extremities and spine (three treatments/week
for 2 wk, two treatments/week for 3 wk and one treatment/week for 4 wk),
ultrasound over the carpal tunnel and nocturnal wrist supports. MAIN
OUTCOME MEASURES: Outcome measures were pre- and postassessments of
self-reported physical and mental distress, nerve conduction studies and
vibrometry. RESULTS: There was significant improvement in perceived comfort
and function, nerve conduction and finger sensation overall, but no
significant differences between groups in the efficacy of either treatment.
CONCLUSIONS: Carpal tunnel syndrome associated with median nerve
demyelination but not axonal degeneration may be treated with commonly used
components of conservative medical or chiropractic care.
: J Manipulative Physiol Ther. 1994 May;17(4):246-9.
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pub
med_pubmed&from_uid=8046280>Related
Articles, Links
Chiropractic manipulation in carpal tunnel syndrome.
Valente R, Gibson H.
Department of Chiropractic Principles and Practice, Cleveland Chiropractic
College and Clinic, Kansas City, MO.
OBJECTIVE: To determine if chiropractic manipulation could relieve carpal
tunnel syndrome (CTS). CLINICAL FEATURES: A 42-yr-old female suffered from
pain, tingling and numbness in the right wrist. Paresthesia along the C6
dermatome, a positive Phalen's test and Tinel's sign was present. EMG
testing confirmed the clinical diagnosis of CTS. INTERVENTION AND OUTCOME:
Chiropractic manipulations were rendered 3 times per week for 4 wk, to the
subject's cervical spine, right elbow and wrist using a low amplitude,
short lever, low force, high velocity thrust. Significant increase in grip
strength and normalization of motor and sensory latencies were noted.
Orthopedic tests were negative. Symptoms dissipated. CONCLUSION: In this
case study, chiropractic made a demonstrable difference through objective
and subjective outcomes. Further investigations using double-blind,
cross-over designs with larger samples are warranted.
J Okla State Med Assoc. 2002 Jan;95(1):7-14.
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pub
med_pubmed&from_uid=11799804>Related
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Conservative treatment of carpal tunnel syndrome: an outcome study of
adjunct exercises.
Seradge H, Parker W, Baer C, Mayfield K, Schall L.
Orthopaedic & Reconstructive Center, 1044 SW 44th Street, 6th Floor,
Oklahoma City, OK 73109, USA.
We conducted a prospective study to evaluate the effect of a new
non-surgical protocol for treating carpal tunnel syndrome (CTS). It
incorporates the Carpal Tunnel Decompression Exercise Program (Exercise
Program) into conventional non-surgical treatment. Twenty-eight patients
(33 hands) met the inclusion criteria and were followed for 18 months. The
outcome measurement tools used were the Symptom Severity Scale (SSS) and
the Functional Status Scale (FSS). The outcome tools were administered at
admission and repeated at 1, 2, and 18 months after admission to the
treatment program. Using the adjunct treatment, 80% of the hands in the
mild category and 71% in the moderate category were successfully treated
without surgery. All patients in the severe category required surgery. The
average success rate of our adjunct non-surgical treatment protocol was
67%, a substantial improvement over the 18% to 34% success rate reported
nationally for conventional treatment methods. Furthermore, improvement in
the outcome of carpal tunnel syndrome by the adjunct non-surgical treatment
can result in significant savings in human suffering, medical cost, lost
work time, and socioeconomic distress.
PMID: 11799804 [PubMed - indexed for MEDLINE]
J Am Osteopath Assoc. 1998 Dec;98(12):679-86.
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med_pubmed&from_uid=9885488>Related
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Comment in:
*
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abst
ract&list_uids=9885484>J
Am Osteopath Assoc. 1998 Dec;98(12):662.
Manipulative treatment of carpal tunnel syndrome: biomechanical and
osteopathic intervention to increase the length of the transverse carpal
ligament.
Sucher BM, Hinrichs RN.
Center For Carpal Tunnel Studies, Paradise Valley, AZ 85253, USA.
SucherCTS@msn.com
To quantify the amount of transverse carpal ligament (TCL) elongation in
response to osteopathic manipulation or sustained load bearing (or both), a
study involving seven cadaver limbs was conducted. Distances from the
trapezium to the hamate (distance A) and from the scaphoid to the pisiform
(distance B) were measured in five mounted cadaver limbs during and after
the limbs bore the weight (2 newtons [N] to 4 N) for 2 several-hour
periods. A several-hour period occurred between the weight bearing to
assess recoil. Distances A and B were measured before and after the limbs
were manipulated, according to previously described techniques, as well as
with a new maneuver, termed the "guywire" technique. Two dissected limbs
also were subjected to further weight bearing, this time increased to 8 N.
Greater weight loads produced greater lengthening of the TCL, and recoil
after removal of weight loads was slower than recoil after manipulation.
Manipulation was more effective than weight loading for increasing distance
A (distal canal), but weight loading generally was more effective than
manipulation for increasing distance B (proximal canal). The guywire
manipulation combined with direct transverse extension appeared to have the
greatest impact on lengthening the TCL distally. These results show promise
for the effective use of manipulation and load bearing for TCL elongation
and nonsurgical relief of pressure on the median nerve in patients with
carpal tunnel syndrome.
PMID: 9885488 [PubMed - indexed for MEDLINE]
References
1. Tetro AM, Evanoff BA, Hollstein SB,
Gelberman RH. A new provocative test
for carpal tunnel syndrome. Assessment
of wrist flexion and nerve compression. J
Bone Joint Surg Br. 1998:80(3):493-8.
2. Davis PT, Hulbert JR, Kassak KM,
Meyer JJ. Comparative efficacy of con-servative
medical and chiropractic treat-ments
for carpal tunnel syndrome: a
randomized clinical trial. J
Manipulative Physiol Ther.
1998;21(5):317-326.
3. Davis PT, Hulbert JR. Carpal tunnel
syndrome: conservative and nonconserva-tive
treatment. A chiropractic physi-cian’s
perspective. J Manipulative
Physiol Ther. 1998;21(5):317-326.
4. Swenson RS. Double crush syndrome;
what is the evidence? J Neuromusculo-skeletal
Sys. 1993 1:23-29.
5. Richardson JK, Forman GM, Riley
B. An electrophysiological exploration of
the double crush hypothesis. Muscle
Nerve. 1999:22(1):71-77.
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