00:00
Carpal tunnel syndrome
is a common condition
that's very amenable to osteopathic
manipulative medicine.
00:06
We’re going to talk about
carpal tunnel syndrome.
00:09
Carpal tunnel syndrome is the most
common focal peripheral neuropathy.
00:13
It happens when you have a
compression of the median nerve
as it innervates the wrist and goes through
the transverse carpal ligament.
00:21
Here is a sign of the radial,
ulnar, and median nerves.
00:26
Here’s another representation showing
where the median nerve goes
and how it’s going to affect the hand.
Carpal tunnel syndrome
occurs with repetitive hand motion.
It is something that the median nerve
will innervate lumbricals 1 and 2,
the opponens pollicis,
the abductor pollicis brevis,
and the flexor pollicis brevis.
00:52
We use the mnemonic Meat-LOAF to remember
that the median nerve innervates these muscles.
00:56
These are also the muscles that would atrophy
when carpal tunnel syndrome gets bad.
01:02
It’s also where you’re going to feel the symptoms
of tenderness, numbness and weakness.
01:07
If caught early, carpal tunnel
syndrome can be treated,
and surgery can be avoided, and damage
to the muscles can be avoided.
01:16
Who gets carpal tunnel
syndrome?
We see it in people when they
gain a lot of weight.
01:21
We see it in patients
who are pregnant.
01:23
We see it with specific activities,
a lot of typing or a lot of hand use.
01:27
We also see it in hypothyroidism and diabetes;
when you have dehydration.
01:32
People can get a traumatic carpal tunnel
syndrome from swelling.
01:35
People with malignancy can have swelling
in the carpal tunnel as well.
01:38
The symptoms of carpal tunnel syndrome
are typically pain,
pain and numbness in the distribution area
of the median nerve.
01:47
The numbness stays there. It goes tingling
and it gets worse.
01:51
It’s usually worse at night and it's usually
often relieved with a flicking
or a reversing of the exact motions
that cause the carpal tunnel syndrome.
02:03
So we often call the
hand flicking self OMM.
02:07
When someone comes with symptoms
of carpal tunnel syndrome,
we have to worry about cervical
radiculopathy or chronic tendinitis,
a pronator teres syndrome or
any of these other conditions
that can cause symptoms similar
to carpal tunnel syndrome.
02:21
Once you’ve ruled out these other symptoms
mostly through physical exam,
you can move forward and
figure out how to treat it.
02:30
You want to confirm with
a physical test, a physical diagnostic test.
02:33
It’s called Phalen’s where you
put the wrist together
at 90 degrees and hold it for about one
minute and seeing if you reproduce
the symptoms of paresthesias, of numbness
and tingling in the fingers.
02:45
The other test that we commonly do
is called Tinel’s sign.
02:48
You take two fingers and tap
over the median nerve.
02:52
You see if you get a shooting pain
of reproduction of the paresthesias
and of pain in the area
of the median nerve.
02:59
When you examine the patient,
you may notice thenar atrophy
if the patient’s had a carpal
tunnel syndrome for a while.
03:08
There may be weak
abduction of the thumb.
03:11
You may also notice a decrease
in two point discrimination
because of the swelling’s
effect on the nerve.
03:17
We can also give a questionnaire
to a patient
to find out about
their symptoms.
03:22
We can do electrodiagnostic testing
to see if there’s delayed conduction
or slowing of nerve conduction
through the median nerve.
03:30
Those are definitive tests for
carpal tunnel syndrome.
03:33
The osteopathic considerations include ruling out
upper thoracic somatic dysfunction,
carpal tunnel somatic dysfunction, and
a viscerosomatic reflex
involving the myocardium,
the lungs, and the esophagus.
03:48
If you use the five models approach
of evaluating a patient,
you can look at both respiratory-circulatory model
and the neurologic model
to explain what’s going on here. There are
biomechanical issues as well.
04:02
Biomechanical thinking of the
impingement of the median nerve
is also part of what’s going on. OMT is a very common and very effective treatment
that will reduce the myofascial
restrictions going on.
04:15
It includes self stretching as well as stretching
by the OMT provider of the area.
04:21
There are three techniques
we want to go over.
04:24
There will be videos of these that
you can look at as well.
04:27
The first is a myofascial
release technique.
04:30
In the myofascial release technique,
you put your fourth and fifth digits
of both hands between the
patient’s fourth and fifth digits.
04:39
So you hold the hand. You extend it slightly
and then you can treat the area.
04:45
You dorsiflex the wrist and then you stroke
the area allowing for enhanced motion.
04:53
I will show you a video
so you can see it better.
04:57
The next technique is the
opponens rolls maneuver.
05:01
This is when you take the thenar carpal ligament
and you work to release it
by grasping the patient’s thenar
and hypothenar areas.
05:09
Then you pull on the thenar area internally
while moving the thumb
into extension so you create some
traction to that space.
05:19
Again there’ll be a video of the
opponens rolls maneuver.
05:22
The last technique is called the
bilateral thumb pressure technique.
05:26
In this technique, you hold the distal forearm
with the thumbs on both sides.
05:32
You contact the anterior aspect of the forearm muscle and the interosseous membrane
while the fingers grasp the posterior
aspect of the forearm.
05:41
Once you have that patient
locked up, you want to
exert a gentle force ventrally
to engage the soft tissue.
05:49
You do that in a motion towards the head
and you roll out laterally
until the barrier of tissue
motion is reached.
05:57
We’ll have a video of
this one as well.
06:00
In addition, treatments with NSAIDS are used.
Wrist splinting will limit use
and give this patient a good sense
of when the symptoms are developing
and what needs to be done.
You get more worried
if there is increased sensory loss
or prolonged motor latencies,
if numbness and tingling doesn't go
away and stays there all the time,
and if you see thenar
or hypothenar atrophy.
06:25
Those are signs of worsening of
carpal tunnel syndrome.
06:28
Again, carpal tunnel syndrome
is a common condition.
06:31
It’s an overuse condition. It’s a condition that
osteopathic medicine has a lot to offer.
06:36
These were the treatment methods
for carpal tunnel syndrome.
06:40
I hope you find it useful.
Thank you.