Carpal tunnel syndrome results in a feeling of numbness and/or pain in the hands and arms caused by compression of the median nerve. It is more common post-pregnancy when hormonal changes may cause fluid retention in the arms.
Osteopathic examination of the patient:
During the case history the osteopath should try and discover the factors contributing to the problem. Posture at work or whilst feeding the baby may be putting pressure on the wrist, shoulders, ribs and neck all of which may reduce the bodies ability to drain the fluid back to the heart from the arm. Questions about the patient's endocrine function are important especially thyroid gland as many cases of hypothyroidism have been known to cause carpal tunnel syndrome.
The osteopath observes the patient standing paying attention to spinal curves, neck and shoulders looking for areas of compression or tension. Active movements will include movements of the neck, shoulder, elbow and wrists – again looking for areas of tension and reduced movement.
Osteopathic examination of the patient:
During the case history the osteopath should try and discover the factors contributing to the problem. Posture at work or whilst feeding the baby may be putting pressure on the wrist, shoulders, ribs and neck all of which may reduce the bodies ability to drain the fluid back to the heart from the arm. Questions about the patient's endocrine function are important especially thyroid gland as many cases of hypothyroidism have been known to cause carpal tunnel syndrome.
The osteopath observes the patient standing paying attention to spinal curves, neck and shoulders looking for areas of compression or tension. Active movements will include movements of the neck, shoulder, elbow and wrists – again looking for areas of tension and reduced movement.
Check for goiter.
A full examination including neurological examination (reflexes, power and sensation) as well as checking the pulses.
The osteopath carefully palpates the ribs, cervical spine, pectoral girdle, clavicle, shoulder, elbow, wrist and fingers noting areas of tension.
Osteopathic treatment:
I prefer to work distally, beginning at the neck and shoulder girdle – releasing any soft-tissue tension around the cervical spine, ribs, pectoral girdle and shoulder. This is particularly important not just to relieve any brachial tension around the neck but drainage into the thoracic duct that may be compressed by the clavicle. The osteopath relieves tension distal to the area of pain in order to make room for the fluid to drain (see post on glue ear).
From the shoulder girdle the osteopath examines and treats the soft tissues of the arm, elbow and forearm. When the osteopath treats the wrist he aims to relieve restriction of the soft-tissues around the carpel bones, phalanges and the palmer aponeurosis. The osteopath should try and be gentle and accurate in this area and as usual, knowledge of the anatomy especially the nerves and the carpal bones is invaluable.
Finally the osteopath can introduce efflerrage in the direction away from the wrist to encourage a return of fluid to heart.
Gentle work to the throat, scalenes, oesophagus and hyoid bone to improve thyroid function can be included when appropriate.
The patient should be given advice on posture whilst breast-feeding or work environment to avoid flexing the wrist for too long and also reducing any local pressure on the wrist. The patient should be encouraged to have a blood test if hypothyroidism is suspected.
From the shoulder girdle the osteopath examines and treats the soft tissues of the arm, elbow and forearm. When the osteopath treats the wrist he aims to relieve restriction of the soft-tissues around the carpel bones, phalanges and the palmer aponeurosis. The osteopath should try and be gentle and accurate in this area and as usual, knowledge of the anatomy especially the nerves and the carpal bones is invaluable.
Finally the osteopath can introduce efflerrage in the direction away from the wrist to encourage a return of fluid to heart.
Gentle work to the throat, scalenes, oesophagus and hyoid bone to improve thyroid function can be included when appropriate.
The patient should be given advice on posture whilst breast-feeding or work environment to avoid flexing the wrist for too long and also reducing any local pressure on the wrist. The patient should be encouraged to have a blood test if hypothyroidism is suspected.
1 comment:
I use a similar approach. In addition, I have also found neural mobilization techniques to be very useful in treating CTS, as well as many other presentations involving mechanical compromise of peripheral nerve tissue.
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