• Dr. Brian Abelson

RESOLVING CARPAL TUNNEL SYNDROME – PART 2

Updated: 13 hours ago




  • In part one of this two part article about Resolving Carpal Tunnel Syndrome (CTS), I discussed surgical verses non-surgical approaches that can be used, symptoms, basic anatomy, and physical examination processes.

  • In part two, I will discuss recommended manual therapy options and supporting exercises. I will provide you with video demonstrations about recommended treatments and exercises that we often provide, to our patients, and review the pros/cons of splints and taping.


MANUAL THERAPY FOR CTS


If the case of CTS is not severe (no muscle atrophy, or significant sensory impairment) then conservative management (manual therapy) should be the first line of treatment. That being said, surgery should not be rule-out if functional changes are not achieved within a reasonable period time.


Fortunately, we have found that most cases of CTS do respond WELL to combinations of nerve mobilizing treatments and nerve gliding exercises. In addition to our nerve-mobilization soft tissue procedures, we also recommend including manual mobilization techniques of the carpal bones.


Here are three reasons we would recommend trying manual therapy first before considering surgery.

  1. Research has shown that patients receiving manual therapy exhibit greater improvements in their pain-pressure threshold compared to those who experience surgery. (16)

  2. Research has shown that manual mobilization of the carpal bones increases dimensional changes in the carpal tunnel. (14). This has been shown to reduce the pressure on the median nerve.

  3. Research has shown that after a period of one year, patients who had manual therapy, combined with exercise, had outcomes comparable to those of patients who had surgery. Additionally, the manual therapy patients experienced quicker improvements at the 1-month time period than surgical patients. (24)


In the following two videos, we will demonstrate some the procedures we frequently use at Kinetic Health to increase mobility of the Median nerve along its pathways. This process does not limit itself to only area of the Carpal Tunnel, but follows the entire pathway of the nerve median from the neck (cervical spine) to the hand.


MSR Nerve Release - Part 1 (Neck to Shoulder)


In this video we focus on releasing, the median nerve from its origin at the neck into the shoulder (cervical plexus to the neurovascular sleeve) using Motion Specific Release procedures.





MSR Median Nerve Release


In this video we will focus on releasing the median nerve using Motion Specific Release procedures to address typical median nerve entrapment syndromes such as Carpal Tunnel Syndrome (CTS), Pronator Teres Syndrome, and Anterior Interosseus Nerve Syndrome.



EXERCISES FOR CTS


CTS is often associated with low aerobic fitness, increased body mass, and lymphatic edema, so specific exercises should also address a wide range of problems. Several factors must be considered when prescribing exercises for CTS. Select exercises that:

  • Address compression on the median nerve.

  • Aid in improving nerve gliding.

  • Correct postural issues and improve strength.


NERVE FLOSSING


Nerve flossing exercises have been shown to decrease pressure on compressed or tethered nerves. (17, 18) The following nerve flossing video is an example of the type of exercises we typically prescribe to our CTS patients. (Perform some of these exercises four or five times per day.)


Median Nerve Flossing Exercises


If you have median nerve entrapment (Carpal Tunnel or some other related nerve entrapment syndrome), then use the exercises in this video to floss, mobilize, and release this nerve from its surrounding tissues.





TAI CHI


Tai Chi is a remarkable form of low impact exercise. The research on Tai Chi is substantial, and has shown that it: (25, 26, 27, 28, 29, 30, 31)

Due to its many benefits Tai Chi is a great form of exercise to integrate into patient exercise routines. The following two videos demonstrate some of the possible Tai Chi related exercises you could integrate into your exercise prescriptions. The first video integrates Tai Chi into some conventional stretching exercise routines. The second is designed to loosen the shoulders and decrease edema.


A Different Computer Break - Releasing Wrist, Hand, and Arm Tension


I often combine these movements with our nerve flossing exercises to aid our patients in their recovery, and have found that they are able to achieve remarkable results.




Tai Chi Shoulder Release


In this modification of “Fair Lady Works at Shuttles” I show you an easy way to decrease the tension in both shoulders.







Note: In addition to these exercises, we would also prescribe appropriate strengthening, and proprioceptive exercise when we determine the patient is ready to do so.



BRACES & TAPING – WHEN TO USE THEM


Braces/Splinting


Braces are used in some CTS cases to correct biomechanical alignment. Braces are most effective when they are custom made to provide three degrees of ulnar deviation, and two-degrees of wrist flexion (neutral position). (12).


CTS patients often have increased symptoms at night due to wrist-bending. The use of a night splint can provide considerable relief for many patients. Since they help to keep the wrist in a straight, neutral position. Just make sure that the splint is not too tight, since over tightening a brace can increase pressure on the carpal tunnel, causing a worsening of symptoms.


It is important to note that while braces/splints often help to decrease pain for the short term, they do NOT provide long-term relief or solution. Wearing a brace/splint can take pressure off the wrist when lifting or performing repetitive motion, but wearing it all the time could lead to increased joint stiffness and loss of muscle strength in the arm and wrist.


Taping


Taping can aid in improving stability of the ulnar-carpal joint. In addition, carpometacarpal radial taping can reduce swelling (edema), decrease pain and provide support. Taping can also act as a biofeedback device, reminding the patient to keep their wrist in a neutral position when typing or performing other repetitive actions. (11)


CONCLUSION – RESOLVING CARPAL TUNNEL SYNDROME


Carpal Tunnel Syndrome is NOT a condition that you can put aside in the hope that it will just go away! If the case of Carpal Tunnel Syndrome is not severe (no muscle atrophy, or significant sensory impairment) then conservative management (manual therapy + exercise) is often successful in addressing this condition.


In my clinical opinion, manual therapy should always be your first choice in addressing this condition. That being said, certain cases of CTS may require surgery, so always keep that option open.


RESOLVING CARPAL TUNNEL SYNDROME - PART 1

RESOLVING CARPAL TUNNEL SYNDROME - PART 2


DR. BRIAN ABELSON DC.

Dr. Abelson believes in running an Evidence Based Practice (EBP). EBP's strive to adhere to the best research evidence available, while combining their clinical expertise with the specific values of each patient.

Dr. Abelson is the developer of Motion Specific Release (MSR) Treatment Systems. His clinical practice in is located in Calgary, Alberta (Kinetic Health). He has recently authored his 10th publication which will be available later this year.




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