Monday, April 10, 2017

Physical Therapy as Good as Surgery for Carpal Tunnel Syndrome

Surgery is a common approach to treat carpal tunnel syndrome. But physical therapy may work just as well, a new study indicates.

Researchers found that physical therapy – particularity so-called manual therapy – improved hand and wrist function and reduced pain as effectively as a standard operation for the condition. Moreover, after one month, physical therapy patients reported better results than those who underwent surgery.

“We believe that physical therapy should be the first therapeutic option for almost all patients with this condition,” said lead study author Cesar Fernandez de las Penas. “If conservative treatment fails, then surgery would be the next option,” said de las Penas, a professor of physical therapy at King Juan Carlos University in Alcorcon, Spain. Also, one extra benefit of therapy over surgery may be cost savings, he noted.

Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes squeezed at the wrist. It often arises from repetitive motions required for work, such as computer use of assembly line work. Symptoms usually start gradually, with patients noticing numbness and weakness in the hand and wrist.

Surgery for the condition generally involves cutting a ligament around the wrist to reduce pressure on the median nerve, according the U.S. National Institutes of Health.

For this study, de las Penas and his colleagues followed 100 women from Madrid who had carpal tunnel syndrome. Half were treated with physical therapy and half underwent surgery.

For three weeks, the therapy patients received weekly half-hour manual therapy sessions – meaning therapists used only their hands. The therapists focused on the neck and median nerve. They also applied manual physical therapy to the shoulder, elbow, forearm, wrist and fingers. On their own, patients performed neck-stretching exercises at home.

After one month, the therapy group reported greater daily function and greater “pinch strength” between the thumb and forefinger compared to the surgery patients. After three, six and 12 months, however, improvements were similar in both groups. All participants experienced similar reductions in pain.

The study results were published in the March issue of the Journal of Orthopaedic & Sports Physical Therapy.

My Take:
First of all the median nerve forms from the brachial plexus between the neck and shoulder, not in the forearm. That’s why manual treatment must be directed to the neck, shoulder, elbow and wrist to increase the success rate.

Using the QA (Quintessential Applications) protocol, I test each articulation looking for any structural imbalances. I also use the “pinch strength” test before and after each manipulation to evaluate the response to treatment. Typically, hand strength will return immediately after manipulation of the primary problem.

Most cases of Carpal tunnel syndrome resolve with one or two treatments. However, the primary cause is most commonly entrapment of the median nerve at the shoulder rather than the wrist. The more chronic the case, the more likely additional joints will be compromised.

Nutritional support is usually to reduce inflammation. But if I find any evidence of neuropathy (nerve damage) then inositol, St. John’s wort, vitamin B6 or B12 may be needed.

The Bottom Line:
If you have symptoms of Carpal tunnel syndrome seek treatment with a chiropractor that is well versed in AK (applied kinesiology). The treatment is quick, effective, and low cost.

March 24, 2017 National Institutes of Health

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