I'm Brett DeGoyer. I'm a primary care sports medicine specialist and neuromusculoskeletal medicine specialist, practicing for Samaritan Healthcare in Moses Lake, Washington. So in this case, we're dealing with carpal tunnel syndrome. Usually happens from a lot of repetitive motion with the hands, with the wrists. You'll see it a lot in people who are doing a lot of keyboarding, a lot of twisting, a lot of paddle motion. And what's happening is inflammation and pressure are building up in the carpal tunnel. So you have the flexor retinaculum that comes across the palmar side or volar side of the wrist and creates this tunnel that the median nerve runs directly through in addition to the flexor tendons for the digits. It sends sensation to these three fingers, the thumb, the index finger, and the middle finger. And so the complaint, of course, is weakness and numbness and tingling in this area. If it's fairly advanced, you'll start to see some atrophy in the thenar eminence. So one of the first approaches for manual treatment is to open up that space and to stretch it out. To get that retinaculum a little bit wider, open up the tunnel so a lot of that fluid then can be drained off by the lymphatic and vascular system, thus reducing the pressure on that median nerve. The way I like to do that first is to just put a thumb on either side of the radiocarpal joint, the volar side, using some of the bony prominences such as the pisiform or the hook of the hamate on one on the pinky side and then hooking my thumb directly over the top of the CMC joint and just inducing a little bit of extension at the wrist and then pulling my thumbs apart. And now I'm showing you exaggerated in order to stretch that flexor retinaculum. As I induce a little bit more extension, that'll give me more stretch. Now keep in mind as you induce a lot of extension, that's actually going to compress along the carpal tunnel. So you need to be up front with the patient and educate them that what you're trying to do is stretch that tunnel, but they may get some symptoms as you're doing this treatment. Once that's done and I want a deeper stretch, I'll hook through the pinky with my pinky, hook through the thumb with my other pinky, and I'll grab on the hands on the hypothenar side and on the thenar side and then I'll induce even more stretch. And then one of the things I'll do is also compress up with the pinky-sided hand or the hypothenar up towards the elbow. And that will help to open the space of the carpal tunnel as well. And I hold that until I feel something relaxed through the wrist and the forearm or the patient tells me that the numbness and tingling sensations that they're having are starting to resolve. After I've done those two treatments, then I'll do an articulatory treatment. And that consists of me pushing on either side of where the median nerve should be running, trying to get into the carpal bones. Then I'll have the patient lean back just a little bit to add traction through the radiocarpal joint. And then I'll just move the wrist in a circular motion one direction and then the other. And then I'll do a figure of eight motion in one direction and then the other. And that helps to articulate the carpal bones and that radiocarpal joint further laxening or loosening that carpal tunnel space and helping to alleviate the symptoms. And of course this is a treatment that should be done with some frequency over a period of six to eight weeks, either once a week or once every other week. And then always educate the patient to be doing their own exercises with stretching at home to help complement what you're doing in the clinic.

3rd Edition, CASE 58

3rd Edition

Wrist

carpal tunnel syndrome

wrist exercises

median nerve

manual techniques

sports medicine