00:00
Impingement neuropathies are a common presentation with patients. These impingements are usually due
to some sort of myofascial restriction and could be potentially improved by applying OMT. So there's
thoracic outlet syndrome where the nerves are being compressed as it exits the cervical spine
and goes and innervates the arm. There is carpal tunnel syndrome where you have compression of the
median nerve at the carpal ligament. You could have ulnar nerve compression both possibly at
the elbow and the wrist. Cubital tunnel syndrome also at the elbow. You could have herniated disc
syndrome pretty much anywhere along the spine but it's definitely more common in the lower cervical
and in the lumbar spine. Tarsal tunnel compression could occur by the ankle and then cranial nerve
compression as the cranial nerves exit the skull. So, overall treatment goals with patients that
have impingement neuropathies with OMM, in general OMT is applied to try to remove those
restrictions that may contribute to compression. Understanding the anatomy of how those nerves
course through the body will help guide you with how you could treat patients. Using myofascial
release to decrease any muscle spasm surrounding the area is helpful. There is a facilitated
positional release pretty much directing treatment for lumbar discogenic pain. Counterstrain could
be used for specific regions where there is muscle spasm and pain. Muscle energy to improve joint
mobility and then carpal tunnel release specifically to help decrease restrictions by the wrist.
01:39
Taking a closer look at carpal tunnel syndrome, remember carpal tunnel syndrome is due to
compression of the median nerve as it passes through the carpal tunnel. Signs and symptoms might be
weakness of the thenar muscles. Patients may complain of decreased grip strength, loss of sensation
or numbness and tingling along the distribution of the median nerve, possible atrophy of the thenar
muscles. Patients may have a positive Tinel’s sign or they also may have a positive prayer or Phalen
sign. We want to utilize OMT to try to mobilize the bones in the wrist. You could also utilize
muscle energy to try to increase wrist joint mobility. Patients with carpal tunnel usually will have
a lot of restriction to wrist extension, so muscle energy is a great technique to utilize. We have
restrictions of the carpal ligament and so what we could do is to try to decrease the restrictions
on the carpal ligament which is like the roof of the carpal tunnel by using balanced ligamentous
tension or myofascial release and then edema definitely worsens carpal tunnel so we want to try to
promote lymph drainage, free up the inlet, treat any restrictions to possible lymph flow and
potentially use an upper extremity lymphatic technique to help decrease that swelling. Thoracic
outlet syndrome is another impingement syndrome that could be treated with OMT. Patients with
thoracic outlet syndrome will complain about pain, numbness and tingling shooting down their
arm, you will suspect this more when their entire arm is hurting not just a specific distribution.
03:13
So, there are 3 key areas where the brachial plexus could be compressed as it comes down and
innervates the upper extremity. So we want to take a look at all 3 areas and possibly utilize OMT to
address restrictions. So, the first region where the brachial plexus could be compressed is as it
passes between the anterior and middle scalene muscles where it attaches to the first rib. The
second area is the costoclavicular space, pretty much the space between that first rib and clavicle.
03:46
And then the third area is by the pec minor and so these 3 areas are key areas to look at in
the structures that may affect the mobility and the motion and movement is an important thing
to address with OMT. So, OMT should be utilized to help address any sort of musculoskeletal spasms
of the scalene muscles and the neck. You could utilize muscle energy, FPR, myofascial release.
04:15
You want to definitely treat any somatic dysfunctions of the clavicle, the upper ribs and the
thoracic spine. You could use thoracic outlet release, myofascial, muscle energy, articulatory
technique. All these techniques are good as long as you could try to get decrease muscle spasm and
increased range of motion of these ribs and clavicle. You could utilize the pec lift, muscle energy
or inhibition to try to treat the pectoralis muscles when the pectoralis muscles are spasmed.
04:43
It's going to compress and potentially impinge on those nerves as it exits into the arm. So, all
these different treatments could be utilized. The main thing is to remember how the brachial plexus
courses into the upper extremity and how you could address those different structures to help
with these symptoms. Other neurologic conditions to consider include chronic pain syndrome such as
fibromyalgia and reflex sympathetic dystrophy. These are more broad-based, patients that come in
with pain in multiple regions or with reflex sympathetic dystrophy, patients that had some sort
of trauma which then has led to chronic pain. So, in general OMT could be applied to help treat
our patients with chronic pain. Treatment goal of OMT is to try to approach the patients of all
models and trying mostly passive indirect techniques. Most of the times patients with chronic
pain syndrome don't tolerate acute active techniques. So utilizing myofascial release or facilitated
positional release, counterstrain, balanced membranous tension, balanced ligamentous tension
and cranial OMM are good approaches for these patients and so these patients usually will benefit
from an approach where you're trying to balance autonomics, decreasing any sort of biomechanical
strains and then promoting circulatory and lymphatic flow, decreasing the overall allostatic
load and also to counsel them with how to deal and manage their chronic pain issues. So in
conclusion, there is definitely a role for OMT in a variety of neurologic conditions. There have
been multiple case reports published, some pilot studies looking at how OMT could help with these
neurologic conditions but overall if you understand the basic anatomy and physiology behind these
different neurologic complaints and issues and apply OMT utilizing the 5 models you could
definitely help benefit patients with these different neurologic conditions.