Over the past two weeks, I have been treating a patient with
carpal tunnel syndrome. Carpal tunnel syndrome is a median nerve
entrapment neuropathy, which causes paresthesia, pain, numbness,
swelling, and other symptoms in the wrist and hand. The symptoms
mainly occur around the thumb, index and ring fingers. These
symptoms are due to compression of the median nerve in the carpal
tunnel of the wrist.
The wrist carpal bones and a connective tissue covering called
the flexor retinaculum make the carpal tunnel. Several structures
pass through the tunnel including: flexor digitorum profundus
tendons, flexor digitorum superficialis tendons, and flexor
pollicis longus tendon, and the median nerve. Some of the main
causes are diabetes, obesity, pregnancy, hypothyroidism, and heavy
manual work especially with vibrating tools.
The treatment I have been using is a combination of chiropractic
manipulative therapy, instrument-assisted soft tissue manipulation,
acupuncture, therapeutic exercises, and supplementation. With this
combination, I have been able to take the patient from an 8/10 to
1/10 on the visual pain scale with almost no remaining
The main chiropractic manipulation I use for carpal tunnel
syndrome is called the opponens roll. The doctor takes a contact
over the palmer side of the wrist and spreads the flexor
retinaculum with a force applied. Patients get a lot of relief with
this adjustment due to stretching of the flexor retinaculum and
increased cross-sectional area of the carpal tunnel.
Acupuncture has also been a very effective tool in the
management of carpal tunnel syndrome, especially with the pain and
swelling. Some of the main points I have been using include: Liver
4, Lung (LU) 7, LU8, LU9, LU10, Pericardium (PC) 5, PC6, PC7, PC8,
and Heart 7.
Finally, I recommended that the patient supplement with
pyridoxine or vitamin B-6. This has been shown to help with carpal
tunnel syndrome by facilitating biosynthesis of pain-relieving
serotonin, reducing excitatory neurotransmitter glutamate, and a
diuretic effect through inhibition of anti-diuretic hormone.
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