Guide to Carpal Tunnel Syndrome Osteopathy and Prescriptive Exercise

Carpal Tunnel Syndrome Treated with Osteopathic Manipulative Treatment

Carpal tunnel syndrome (CTS) is 1 of the most common peripheral nerve entrapment disorders. Osteopathic manipulative medicine can be invaluable in diagnosing and managing CTS. Combined with a patient’s history and a standard physical examination, an osteopathic structural examination can facilitate localizing the nerve entrapment, diagnosing CTS, and monitoring the disease process. Osteopathic manipulative treatment is noninvasive and can be used to supplement traditional CTS treatment methods. The authors also review the relevant anatomy involving CTS and the clinical efficacy of osteopathic manipulative medicine in the management of this disorder.

Carpal Tunnel Syndrome

 

Carpal Tunnel Syndrome

What is the Purpose of Prescriptive Exercise?

There are a number of theories regarding how exercise and mobilisation interventions are effective in reducing the symptoms of Carpal Tunnel Syndrome. Gliding exercises can potentially reduce tenosynovial oedema, improve venous return from the nerve bundles, and reduce pressure inside the carpal tunnel.

Whereas stretching may relieve compression in the carpal tunnel, improve joint posture and decrease nerve compression, and improve blood flow to the median nerve. Stretching exercises for Carpal Tunnel Syndrome have been prescribed for the same reasons, and also to mobilise the median nerve within the carpal canal if it is adherent (Page et al. 2012).

What is the Purpose of Osteopathic Manipulative Treatment

When osteopathic structural examination reveals somatic dysfunction associated with Carpal Tunnel Syndrome, osteopathic manipulative treatment may be used to manage the somatic dysfunction. Specifically, OMT may be used to stretch soft tissues, release tissue adhesions, eliminate restricted motion of carpal and metacarpal bones, increase the length of the TCL to enlarge the carpal tunnel and lower intratunnel pressure transmitted to the median nerve, increase range of motion, strengthen muscles, and reduce edema (Siu et al. 2012).

Resultant improvements in circulation and joint function will allow for normalization of nerve function. As described in the following paragraphs, several techniques can be used to manage somatic dysfunction in various parts of the wrist and hand that are associated with Carpal Tunnel Syndrome (Siu et al. 2012).

What Techniques can be applied to Carpal Tunnel Syndrome?

Myofascial release technique—The physician places his or her fourth and fifth digits of both hands between the patient’s fourth and fifth digits and first and second digits of the palmar surface (Siu et al. 2012).

Opponens roll maneuver—This maneuver involves lateral and axial rotation of the thumb, which creates substantial traction on the attachment of the opponens pollicis muscle. The muscle originates from the transverse carpal ligament and tubercle of the trapezium bone. This maneuver stretches the muscle and transverse carpal ligament, releasing pressure within the carpal tunnel and unloading pressure on the median nerve (Siu et al. 2012).

High-velocity, low-amplitude technique (mobilization with impulse)—The physician’s hands grasp the patient’s hand and wrist where the technique can be either directed at Carpal Bones, Metacarpophalangeal Joint, Carpometacarpal Joint, Radius and Ulna (Siu et al. 2012).

Muscle energy technique for pronation and supination dysfunctions—To manage pronation dysfunction, the physician holds the patient’s hand in a handshake position while the palm of the free hand contacts the posterolateral aspect ofthe radial head to be treated. Supination is applied to the patient’s forearm until a restrictive barrier is reached (Siu et al. 2012).

Is Treatment Effective for Carpal Tunnel Syndrome?

One trial showed Osteopathic manipulative treatment effectively managed Carpal Tunnel Syndrome symptoms and disability in 9 participants.  However,
median nerve function and morphology did not change as measured before and after 6 weeks of OMT (Burnham et al. 2015).

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Reference List

Burnham T, Higgins DC, Burnham RS, Heath DM (2015). Effectiveness of osteopathic manipulative treatment for carpal tunnel syndrome: a pilot project. J Am Osteopath Assoc. Mar;115(3):138-48

Page MJ, O’Connor D, Pitt V, Massy-Westropp N (2012).  Exercise and mobilisation interventions for carpal tunnel syndromeCochrane Database Syst Rev.  Jun 13;(6):CD009899

Siu G, Jaffe JD, Rafique M, Weinik MM (2012). Osteopathic manipulative medicine for carpal tunnel syndrome. J Am Osteopath Assoc. Mar;112(3):127-39

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