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Brandon Masi Parker discusses Carpal Tunnel Syndrome (CTS).  The CTS discussion includes definition, epidemiology, pathophysiology, clinical presentation, diagnosis and treatment.

Carpal Tunnel Syndrome podcast

Video for Provocative Maneuvers in CTS diagnosis

Carpal tunnel syndrome (CTS) is the most commonly diagnosed and treated nerve entrapment syndrome, affecting approximately 3-6% of the population.1 CTS can present as an acute form caused by a major trauma, or more often as a chronic condition.2  Although the etiology of CTS varies, the most common cause is repetitive stress injury to the wrist, leading to flexor tenosynovitis.3  The symptoms of CTS are caused by compression of the median nerve at the wrist, with ischemia and impaired axonal transport of the median nerve across the wrist.4  The standard first line treatment for CTS is rest, immobilization, avoiding aggravating activities and modifying physical activities, and nonsteroidal anti-inflammatory drugs (NSAIDs).  Conservative treatment is effective in approximately 80% of patients but if these modalities fail, positive results ranging from 56-73% of patients treated has been seen with local anesthetics and corticosteroid injections.5  If these treatment options are unsuccessful then surgery is indicated.  Studies comparing surgical versus non-surgical patients have shown symptoms improving in both groups but with surgical treatment leading to a better outcome than current nonsurgical.6  Complications among these surgical procedures are uncommon. Approximately 1-2% of patients, experience nerve, tendon, and blood vessel laceration, infection, scar tenderness, damage to the median nerve, pain, hematoma, reflex sympathetic dystrophy, and potential repeat surgery if the procedure is unsuccessful.7,8

Among the non-surgical techniques available is osteopathic manipulative treatment (OMT), which was shown to be a safe and effective method of treatment for mild to moderate CTS.9  The goal of OMT in the treatment of CTS is to stretch soft tissues, release tissue adhesions, free restricted metacarpal and carpal bones, increase range of motion, strengthen the muscles, and remove edematous fluid, resulting in improvement in circulation and nerve function.3  Sucher was able to show through MRI measurements that manipulation is capable of increasing the transverse and AP dimensions of the carpal canal.  Sucher also showed improvement in nerve conduction studies within 1-3 months of manipulative treatment.9  Median sensory and motor nerve conduction studies have been shown as valid and reproducible clinical laboratory studies that confirm a clinical diagnosis of CTS with a high degree of sensitivity and specificity.10  However, Sucher’s studies were conducted with small sample sizes, with test groups ranging from 4-9 patients and a control group of 13 patients.  Although multiple studies have shown the effectiveness of osteopathic manipulative medicine for CTS, future research to enhance the clinical efficacy is still warranted.3

1)      Atroshi, I., et al. Prevelance of carpal tunnel syndrome in a general population. Jama 282, 153-158 (1999)

2)      Naranjo A, Ojeda S, MendozaD, et al. What is the diagnositc value of ultrasonography compared to physical evaluation in patients with idiopathic carpal tunnel syndrome?. Clin /exp Rheumatol. Nov-Dec 2007; 25(6): 853-9.

3)      Siu, G. Osteopathic Manipulative Medicine for Carpal Tunnel Syndrome. AOCPMR.

4)      Lundborg G, Dahlin LB. The pathophysiology of nerve compression. Hand clin. May 1992; 8(2): 215-27

5)      Dammers, J.W., Roos, Y., Veering, M.M. &Vermeulen, M. Injection with methylprednisolone in patients with carpal tunnel syndrome: a randomized double blind trial testing three different doses. J. Neurol 253, 574-577 (2006)

6)      Jarvik JG, Comstock BA, Kliot M, Turner JA, Chan L, Haegerty PJ, et al. Surgery bersus non-surgical therapy for carpal tunnel syndrome: a randomized parallel-group trial. Lancet. Sep 26 2009; 374 (9695): 1074-81

7)      Gerritsen, A.A., et al. Splinting vs surgery in the treatment of carpal tunnel syndrome : a randomized controlled trial. JAMA 288, 1245-1251 (2002)

8)      Boeckstyns, M.E.& Sorensen, A.I. Does endoscopic carpal tunnel release have a higher rate of complications than open carpal tunnel release? An analysis of published series. J Hand surgery 24, 9-16 (1999)

9)      Sucher BM. Palpatory diagnosis and manipulation management of carpal tunnel syndrome. Journal of American Osteopathic Association 1994; 94;647-663

10)  Jablecki CK, AndaryMT, So YT, WilkinsDE, Williams FH. Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome. AAEM Queality Assurance Committee. Muscle Nerve 1994. Dec; 17 (12): 1490-1

In this episode we discuss applying Osteopathic practices and principles to surgery with Dr. Boesler DO.  We discuss the usefulness of applying osteopathic practices and principles in a surgical setting.  We offer anecdotal accounts and information from clinical research to support the effectiveness of applying and understanding Osteopathy’s effect in the surgical field.

Osteopathic Medicine and Surgery Podcast

Below are some cited resources:

Jarski RW et al. The effectiveness of osteopathic manipulation treatment as complementary therapy following surgery: a prospective, match-controlled outcome study. September 2000 77-81

O-Yurvati, A. et al. Hemodynamic Effects of Osteopathic Manipulation Treatment Immediately After Coronary Artery Bypass Graft Surgery. J Am Osteopath Assoc. October 2005 10:105

Stiles, EG. Osteopathic manipulation in a hospital environment. J Am Osteopath Assoc.  December 1, 1976 76:243

Sleszynski & Kelso. Comparison of thoracic manipulation with incentive spirometry in preventing postoperative atelectasis. J Am Osteopath Assoc. August 1, 1993 93:834

Audio Podcast for Knee Pain

The knee is the largest joint in the human body when considering volume and surface area of articular cartilage and the size and complexity of the articulation lend to susceptibility to acute injury, chronic wear and tear and arthritis (inflammatory and septic).  It is important to recognize the various etiologies of knee pain.  This podcast aims to provide an overview of the topic of knee pain and help you develop a differential diagnosis.  We also have a section at the end specifically discussing the somatic dysfunctions of the knee.

Video for Orthopedic Exam of the Knee

Audio Podcast for Bell’s Palsy

Scott Sandilands OMS III discusses a pediatric case study with us on Bell’s Palsy.  We also discuss some etiologies, approach to diagnosis and treatment of both adult and pediatric Bell’s Palsy cases as well as some success that Osteopathic manipulation has had with these patients.

Audio Podcast for Venous Thromboembolism

John Gentile OMS III discusses Venous Thromboembolism.  In this podcast the etiologies, clinical management and risks of Deep Venous Thrombosis and Pulmonary Embolisms will be discussed.  Please join in the discussion with any questions or comments.  We hope to act as a source for review and summary on these topics as well as a catalyst for further discussion on these very pervasive and dangerous pathologies.