This section was compiled by Frank M. Painter, D.C. Send all comments or additions to:Frankp@chiro.org
If there are terms in these articles you don't understand, you can get a definition from the Merriam Webster Medical Dictionary. If you want information about a specific disease, you can access the Merck Manual. You can also search Pub Med for more abstracts on this, or any other health topic.
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There is a huge difference between chiropractic management and medical management of disorders like Carpal Tunnel. There are pictures below of typical medical management. A chiropractor knows that if your hands have pain and tingling, that the first place to look is your neck, specifically in the mid to lower cervical spine. That is where the nerve roots which make up the brachial plexus originate. Then the brachial plexus divides into named nerves like the median and ulnar nerve. You will see the brachial plexus forming from the nerve roots on the right side of this picture.
Between the neck and the wrist, there are many possible locations for “double crush”. What does that mean? If there is irritation of a nerve root at the vertebra (or bones) of the neck, or at the triangle formed between the scalene muscles and the first rib (see the sketch on the left) the nerve itself becomes “sick”. As that nerve passes into the arm, it passes through several muscles before it enters the hand, beneath the transverse carpal ligament. If the nerve is already sick, the “secondary stress” of compression within the arm muscles, or at the wrist, may cause regional symptoms at that location. We call that second insult to the nerve a “double crush” phenomonon. Remember, this nerve has been exposed to those exact same conditions during your whole life without complaint. When a chiropractor adjusts the neck and removes the irritation at the nerve roots, the secondary, or downstream symptoms simply resolve. This is true for entrapment syndromes (which may have developed associated muscle adhesions or “trigger points”) and for the well publicized “carpal tunnel syndrome”.
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Please NOTE that this remarkable series of articles is provided by surgeons. I only list them because of their pictures and anatomical discussions. The recommendations these articles make regarding drug and surgical interventions run counter to the conservative approach provided by a rehabilitation-oriented chiropractor.
If you receive an error when trying to open one of these pages, please go to this website: http://www.eorthopod.com/, and select the TOPIC you want from the left-sided INFORMATION list, and then select the specific article you want to review.
Neurodynamic Mobilization in the Conservative Treatment
of Cubital Tunnel Syndrome: Long-Term Follow-Up of 7 Cases
J Manipulative Physiol Ther. 2010 (Feb); 33 (2): 156–163
This case series demonstrated that conservative treatment of CTS may be beneficial for selected patients with mild to moderate symptoms. The treatment included neurodynamic mobilizations, including sliding techniques and tensioning techniques, which are thought to enhance ulnar nerve gliding and restore neural tissue mobility. Conservative treatment using neurodynamic mobilization with patient education and activity modification demonstrated some long-term positive results.
Occupational Injuries Suffered by Classical Musicians Through Overuse
Clinical Chiropractic 2004 (Jun); 7 (2): 55–66
There is a high rate of injury to professional classical musicians and teachers that can be disruptive to practice and potentially threatening top careers. Females and string players were discovered to be of particular risk. The majority of injuries were to the shoulder and proximal thoracic spine and the absence of injuries in amateur players suggests a relationship to overuse. The author suggests that the incorporation of postural and ergonomic into musical education and chiropractic treatment programmes for classical musicians and teachers could be of benefit.
A Prospective Study of Computer Users I: Study Design and Incidence
of Musculoskeletal Symptoms and Disorders
Am J Ind Med 2002 (Apr); 41 (4): 221–235
Individuals (n = 632) newly hired into jobs requiring > or = 15 hr/week of computer use were followed for up to 3 years. At study entry, workstation dimensions and worker postures were measured and medical and psychosocial risk factors were assessed. Daily diaries were used to document work practices and incident MSS. Those reporting MSS were examined for specific MSD. H/A and N/S MSS and MSD were common among computer users. More than 50% of computer users reported MSS during the first year after starting a new job.
A Prospective Study of Computer Users I: Postural Risk Factors for
Musculoskeletal Symptoms and Disorders
Am J Ind Med 2002 (Apr); 41 (4): 236–249
Six hundred and thirty-two newly hired computer users were followed prospectively to evaluate associations between posture and neck or shoulder (N/S) and hand or arm (H/A) musculoskeletal symptoms and musculoskeletal disorders. Participants' postures were measured at entry and they reported symptoms on weekly diaries. Participants reporting symptoms were examined for specific disorders. Multivariate Cox regression models were used to estimate associations between postural variables and risk of symptoms and disorders, controlling for confounding variables.
The Symptomatic Upper Extremity: An Algorithmic Approach to Diagnosis, Part 1
J American Chiropractic Assoc 1999 (Apr): 36 (4): 32–58
~ FULL TEXT
Numbness in an arm or hand is a common presenting or secondary patient complaint. Carpal tunnel syndrome poses a familiar mechanism and is frequently cited as the cause of the patient's symptoms. While it may be the most common upper-extremity peripheral nerve entrapment neuropathy, a myriad of other nerve entrapment sites and pathologies are capable of producing upper-limb symptoms. In this article, an algorithmic approach by topographical region is utilized to narrow or expand the diagnostic focus.
The Symptomatic Upper Extremity: An Algorithmic Approach to Diagnosis, Part 2
J American Chiropractic Assoc 1999 (May): 36 (5): 30–41
~ FULL TEXT
Numerous condtions, notably nerve entrapment syndromes, account for symptoms in the upper extremities. Some are quite common and familiar, while others are remote. In this article, an algorithmic approach has been utilized to describe a broad variety of neurological and non-neurological conditions and to provide readers with an overview of each. The algorithm is intended to be used by the non-specialist who is interested in expanding his list of differential diagnoses for a patient's complaint. It is a reference tool, not a cookbook for diagnosis. Likewise, a planar diagram cannot provide a definitive diagnosis. Common sense and experience will do that.
Comparison of Physiotherapy, Manipulation, and Corticosteroid Injection
for Treating Shoulder Complaints in General Practice: Randomised, Single Blind Study
British Medical Journal 1997 (May 3); 314 (7090): 1320–1325 ~ FULL TEXT
In the shoulder girdle group duration of complaints was significantly shorter after manipulation compared with physiotherapy (P < 0.001). Also the number of patients reporting treatment failure was less with manipulation. In the synovial group duration of complaints was shortest after corticosteroid injection compared with manipulation and physiotherapy (P < 0.001). Drop out due to treatment failure was low in the injection group (17%) and high in the manipulation group (59%) and physiotherapy group (51%). CONCLUSIONS: For treating shoulder girdle disorders, manipulation seems to be the preferred treatment. For the synovial disorders, corticosteroid injection seems the best treatment.
Chiropractic Manipulation in Carpal Tunnel Syndrome
J Manipulative Physiol Ther 1994 (May); 17 (4): 246–249
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. In this case study, chiropractic made a demonstrable difference through objective and subjective outcomes.
Other Repetitive Stress Resources
Carpal Tunnel Syndrome: Provocative Maneuvers
Carpal tunnel syndrome is one of the most common peripheral entrapment neuropathies encountered in clinical practice. The following clinical tests may be useful to help confirm the diagnosis of carpal tunnel syndrome.