Sindrome del tunel carpiano

ORIGINAL CONTRIBUTION

Manipulative Treatment of Carpal Tunnel Syndrome: Biomechanical and Osteopathic Intervention to Increase the Length of the Transverse Carpal Ligament: Part 2. Effect of Sex Differences and Manipulative “Priming”
Benjamin M. Sucher, DO; Richard N. Hinrichs, PhD; Robert L. Welcher, MS; Luis-Diego Quiroz, BS; Bryan F. St. Laurent, MS; and Bryan J. Morrison, MS

As atheoretical basis for treatment of carpal tunnel syndrome (CTS) and expanding upon part 1 of this study, the authors investigated the effects of static loading (weights) and dynamic loading (osteopathic manipulation [OM]) on 20 cadaver limbs (10 male, 10 female). This larger study group allowed for comparative analysis of results by sex and reversal of sequencing for testing protocols. In staticloading, 10-newton loads were applied to metal pins inserted into carpal bones. In dynamic loading, the OM maneuvers used were those currently used in clinical settings to treat patients with CTS. Transverse carpal ligament (TCL) response was observed by measuring changes in the width of the transverse carpal arch (TCA) with threedimensional video analysis and precision calipers. Results demonstratedmaximal TCL elongation of 13% (3.7 mm) with a residual elongation after recovery of 9% (2.6 mm) from weight loads in the female cadaver limbs, compared to less than 1 mm as noted in part 1, which used lower weight loads and combined results from both sexes. Favorable responses to all interventions were more significant among female cadaver limbs. Higher weight loads also caused more lineartranslatory motion through the metal pins, resulting in TCA widening equal to 63% of the increases occurring at skin level, compared to only 38% with lower loads. When OM was performed first, it led to greater widening of the TCA and lengthening of the TCL during the weight loading that followed. Both methods hold promise to favorably impact the course of management of CTS, particularly in women.

CFrom the Center for Carpal Tunnel Studies in Paradise Valley, Ariz (Sucher), Arizona State University’s Department of Kinesiology in Tempe (Hinrichs, Welcher, Quiroz, St Laurent, and Morrison), and the University of Wisconsin at Eau Claire’s Department of Kinesiology and Athletics (Welcher). Address correspondence to Benjamin M. Sucher, DO, Center for Carpal Tunnel Studies, 10585 N Tatum Blvd, SteD135, Paradise Valley, AZ 85253-1073. E-mail: drsucher@centerforcarpaltunnel.com

linical management of carpal tunnel syndrome (CTS) continues to be a challenge to physicians and their patients, both of whom are often left to struggle with a choice between pursuing limited conservative treatment or surgical intervention in the form of surgical release of the transverse carpal ligament (TCL).1However, osteopathic manipulative treatment (OMT) and stretching exercises have shown promising results when used in combination therapy as a potential treatment modality for CTS, demonstrating an increase in the width of the transverse carpal arch (TCA) as confirmed with nerve conduction improvements and findings from magnetic resonance imaging.2–6 In the first part of this study,7 we measuredactual TCL elongation under direct clinical observation during sustained static loading (weights). The width of the TCA was also measured before and after osteopathic manipulation (OM).7 Both methods confirmed the potential benefit of these non-surgical approaches to enlarge the carpal tunnel and alleviate symptoms of CTS. In addition, these conservative treatment methods produced changes in the TCAthat approached those seen after surgical release of the TCL.8,9 In part 1,7 we used lighter weight loads than were used in the present study. Additionally, part 1 was conducted with a smaller subject group (ie, seven cadaver limbs), minimizing any inherent difference in results by sex. Observations from the use of varying weight loads in the original study also led us to anticipate that higher...