CARPAL TUNNEL SYNDROME
Carpal tunnel syndrome patients can be extremely
frustrating to care for in a conservative medical
setting. Many patients will move too quickly to the
surgical option, without fully considering conservative
approaches, for which there is some evidence of efficacy
and a good safety record.
The rational for
providing chiropractic care in patients with mild to
moderate carpal tunnel syndrome is four-fold:
-
wrist mobilization/manipulation
may allow the nerves to move more freely through the
wrist and adjuncts such as stretching and exercises
to increase forearm and hand strength, may be
important additions to care;
-
patient may have a coexisting neck
disorder which could benefit from manipulation
and/or the nerves coursing through the wrist may be
compromised by a "double crush lesion" at the
cervical joints;
-
your patient's simple
preference to try a non-drug and non-surgical
potential solution; and
-
failure to respond to conservative
medical care such as bracing or medications, and
surgery is being weighed.
As far as the "double crush" theory, the jury is still
out on its validity (Russel BS. Chiropr & Osteopat
2008;16(1):2). In patients with only sensory
disturbances, as opposed to motor weakness, the validity
is more uncertain. Nevertheless, if your CTS patient
also has neck pain, it does provide an additional
indication for adjustments. I have been trained in
specific techniques where displaced/sprained carpal
bones are adjusted.
There are case reports, case series/comparison trials,
and at least one full-scale randomized clinical trial
demonstrating efficacy for chiropractic care in patients
with carpal tunnel syndrome (Vernon R. J Manipulative
Physiol Ther 1994;17:246; Burke J, et. al. J
Manipulative Physiol Ther 2007;30;50; Davis PT, et. al.
J Manipulative Physiol Ther 1998;21:317). Cochrane
reviews on carpal tunnel syndrome and arm complaints,
have reported modest evidence of efficacy for
manipulation/mobilization.
The safety of chiropractic care based on a review of the
evidence, is good. There have been no reported adverse
reactions in trials of CTS patients. Cervical adverse
reactions are also very rare.
A reasonable trial of care would be six to eight visits.
Your patient should show improvement in this time
period. If there were a favorable response to care, it
would justify continued treatment with a gradual
decrease in frequency. |
