I have bad carpal tunnel. I don't like the idea of surgery which is what my MD suggests. I was therefore interested in hearing of any other forms of treatment anyone knows of (OMM?). thanks
There are many techniques used in OMM to treat CTS but few if any have outcome studies regarding such treatment. Typically the noninvasive approach comes from Occupational Therapy, and actually is very good as preventative education to prevent future "flare ups". But with highly suggestive EMG studies, surgery has the best outcome...and with OT introducing prevention, it is difficult to beat. For the interested reader, see this months JAMA re: surgery vs. splinting for CTS.
Thanks for an informative and reasoned reply, (even if I had hoped the answer would instead be that OMM had had positive outcome studies!). I will look up the JAMA article.
One of our OMM instructors (who happens to be a MD) said she treats some of her patients with CTs using OMM.
Wait a second. You're getting carpel tunnel from posting? I need to go do some research on this CT thing.....
well, centrum and others may be getting CT form posting but given the amount of typing I do for my job, I think it'd be a bit unfair for me to blame SDN
There are a few techniques that work well. First streching the palm by applying a wringing out motion. If you look in the AOA Foundations book a couple methods exist. Night splinting and using NSAIDs are very helpful. Not using the affected hand for repetitive actions such as typing! Good luck D
a very important study comparing treatments of carpal tunnel is being published this week in JAMA. In a nutshell, surgical decompression was shown to be signifigantly better than non-operative treatment (splinting) for the most common patient types with the symptoms. This will likely have a large impact on the way CT is treated, chiefly in that it will be easier for you to have the surgery done thru your insurance carrier without jumping thru multiple hoops to get it approved. I expect this will signifigantly incr. the number of these treated operatively in this country
some surgeons are now performing CT surgery with arthroscopic techniques as opposed to opening the wrist. i don't have any research on which is better but the theory is that the arthroscopic procedure will produce less scar tissue to decrease the risk of recurrence. if your CT is bad enough and you're considering surgery you may want to find out more about the different techniques. in any event, PLEASE have it looked at closely. many people come in with CT when it's too late and have extensive atrophy of the muscles innervated by the median nerve. wait long enough and the atrophy is irreversible.
Most of the hand surgeons here @ Kleinert,Kutz, & associates (the largest & most well-known hand practice in the world) do their carpal tunnel releases open rather than with an endoscope. Talking to a few of them, they think there is no advantage to the endoscope & you give up a lot of visualization. A notable exception here is Dr. Tsu Min Tsai who does all his with a scope. I think the endoscope has just really never caught on very widely, although it has its proponents.
The only problem with the recent JAMA article is that it only compares surgery to splinting. What about surgery vs. a combination of other treatments like NSAIDS, OMM, therapy, splinting, etc.? Does anyone know off hand if there are any studies of the sort?
Agreed. Some of the reviewers have also pointed out some of the limitations, specifically the NSAID adjuvant tx. and some multi-modal strategies. Large studies like this often get too complex to interpret if you have too many treatment arms involved. The important thing about the study is that it established the surgical arm to be superior in a very straight forward & tangible way to the most common alternative therapy. Further studies to repeat this will be done I'm sure (and it may or may not be reproducible), as will prospective studies with NSAIDS/Splinting. This is a very empowering study for patients in that it will give them more options for their initial treatment. Its kind of the reverse of the large prospective trial this past summer which showed no benefit to therapeutic arthroscopy for osteoarthritis of the knee as compared to a sham-surgery procedure (a very rare kind of trial these days), which will dramatically decreases the # of those performed because they will not be paid for it. I don't think OMM is a real mainstream tx. for carpal tunnel & has not been published in leading peer review journals devoted to hand surgery that I know of. I'm not sure what the proposed mechanism of how it would be effective would be, do you?
As stated a little earlier, Occupational Therapy seems to have the corner on the market for non-invasive treatment of CTS and there have been some studies regarding the educational benefit of OT/PT and the re-occurance of symptoms. Though I don't know the exact articles, they would likely be found somewhere in The Journal of PT, Journal of Orthopedic and Sports PT, and Journal of theAmerican Occupational Therapy Assn. The real benefit of OMM is teaching HOME stretches etc, in the same manner PT does.
OMM cannot treat disease states. If it is carpal tunnel and carpal tunnel alone, OMM can do nothing and medical care is needed. This is usally not the case. If there is somatic dysfunction that is causing symptoms of carpal tunnel then this can be cured with OMM. This is usually not the case either. Usually it is a combo. of both a disease state (carpal tunnel) and a host component (somatic dysfunction). If proper medical care is administered and the somatic dysfunction removed through OMM, then a faster recovery should be expected over someone who just addressed the disease state. Remember that Host + Disease=Illness Later!
I am a massage therapist and have worked on several clients with wrist pain (and other pain) with a high degree of success. One client in particular had CTS in both wrists but only had the operation on one wrist to see if it worked (this occurred a few months before he became my client). Unfortunately, the pain continued in both wrists, so he did not have the surgery on the second wrist. After working (basic swedish/deep tissue and some craniosacral techniques) on both hands, wrists, forearms, arms, shoulders and upper back for several sessions (5 or 6) , the pain and tingling has begun to subside in frequency. I am hopeful that after a few more sessions that the pain will disappear completely. fyi, my training was basic massage (500 hour program), craniosacral therapy (Upledger Institute) and various other bodywork modalities. Now I am exploring going back to school to be a DO/family practice/psychiatrist. Who knows, maybe I'll see some of you in school! Don
