Carpal Tunnel Syndrome (CTS): Case study

By Dr. Jong H.Oh DC
History:

A 33 years old male butcher presented with numbness in both hands that began four months ago and progressively got worse. Diagnosis by his physician was CTS. Patient stated that the pain is constant, severe (10/10 on visual analog scale) and numbness in character. It is aggravated with flexion and extension of both wrists, and is subsides with rest. Symptoms are worse at night and he is often awake with pain. Patient also stated that he cannot hold his toothbrush in the morning.

Examination:

According to the E.M.G. Nerve Conduction Studies performed by physician, there was electrophysiological evidence of distal nerve entrapment involving the median nerve Rt. And Lt. Median motor and sensory are abnormal. Mild bilateral CTS Lt > Rt in this study. Somatosensory evoked potentials were studied using median nerve stimulations at the wrists. Recordings were made at Erb’s point, CS-2 and contralateral sensorimotor cortex. Wave forms were slightly abnormal in amplitude. Central velocities were normal bilaterally. C6-C7 minor neurogenic change noted.Grip strength as measured with a dynamometer was recorded at 30 kg for the right hand, 25 kg for the left. Static palpation revealed hypertonicity and tenderness over both extensors and flexors of wrists, upper trapezius, and levator scapula. Motion palpation revealed a restricted motion at C5/6/7 levels.

Deep Tendon Reflexes in the upper extremity were graded at a +2 normal response. Dermatome study revealed no sensory deficits over upper extremity. Muscle strengths in the upper extremity were graded at a 5/5 normal response with slight weakness of left wrist flexor and extensor.

For orthopedic tests in the upper extremity, both Phalen’s and reverse Phalen’s tests were positive. Tinel’s test at wrists were also positive. Pinch Grip and Froment’s tests were negative. Cozen’s and Revese Cozen’s tests showed pain in the medial and lateral aspects of the elbows, respectively.

Assessment/Diagnosis:

It is my clinical impression that the patient is suffering from:

Carpal tunnel syndrome

Strain of both wrist flexors/extensors, upper trapezius and levator scapula muscles

Cervical joint dysfunction

Treatment/Outcome:

Treatments consisted of applying Trigenics® Strengthening procedures to the involved upper trapezius/levator scapula, posterior cervicals, common flexor tendon, flexor carpi radialis, carpal bones and wrist flexors, as well as Trigenics® Lengthening procedures to posterior cervicals, upper trapezius, common flexor tendon. Specific myopoints were treated in these muscles with some variations in location depending upon his presentation from treatment to treatment. A fascial release technique described in a textbook of Dr. Hammer and physical modalities were applied in each visit. Chiropractic adjustments were also performed in the lower cervicals and lunate anterior to help restore normal joint mobility. After 5 treatments, patient stated that there was a significant decreased numbness of both hands and that he did not wear wrist braces as often as before. In addition, his grip strength was 35 kg on the right side and 29 kg on the left. Mr. M. has received a total number of 8 treatments to date, at a frequency of 4-5 times per week. I recommended him to continue treatments with 2-3 times per week for another two months.