Carpal Tunnel and Elbow Injuries
Wrist and elbow injuries are primarily due to repetitive sport or occupational activities.
Carpal Tunnel Syndrome
• There are 27 bones that comprise the hand, including 8 carpal wrist bones.
• Carpal tunnel is primarily due to compression of the median nerve as it passes through the carpal tunnel, which is the space between the carpal bones and the flexor retinaculum.
• May be the result of repetitive stress injuries
Symptoms include:
• Pain, numbness, or tingling on the palmar surface of the thumb and radial two and one-half fingers (thumb to middle finger).
• Commonly worse at night or during repetitive activities.
• Weakness of grip strength
Clinical Findings:
• Dynamometer: measures grip strength
• Tinel's test: tapping over median nerve
• Phalen's test: compresses median nerve
• Reverse Phalen's test: stretches median nerve
• Palpation of anterior lunate bone, often tender
• Muscle testing: opponenes pollicis often weak
• NCV (nerve conduction velocity): measures nerve transmission speed via needle
• SSEP (somato-sensory evoked potentials): measures sensory components of localized complaints.
Research:
• 38 CTS sufferers underwent spinal manipulation and extremity adjusting. Post treatment results showed improvement in all strength and range of motion measures, as well as reduction in pain and distress ratings were documented.
(JMPT Vol.13 No.9 Nov/Dec 1990)
• Dr. Susan MacKinnon, professor of surgery at Washington University School of Medicine, in St. Louis , found in a study of 64 patients: with repetitive stress disorders of who 34 had wrist surgery it was discovered that wrist pain still existed in most cases after the surgery. “The high failure rate of surgery has caused me to rethink the cause of CTS.”
(Journal of Hand Surgery, Sept 1994, 873-883)
Treatment:
• Night splinting in neutral or slightly extended wrist position
• Wrist exercises and stretches
• Avoid repetitive activities
• Complex B vitamin supplementation
• Specific wrist adjustments by your chiropractic certified extremity practitioner
• Surgical release of flexor retinaculum (last resort)
Tennis Elbow (Lateral Epicondylitis)
• Primarily due to overuse of wrist extensors as seen in tennis athletes (back hand) or with repetitive use of a screwdriver.
Clinical Findings:
• Tenderness to touch at the lateral epicondyle, origin of the extensor carpi radialis brevis.
• Cozen's, Mill's, and Tinel's test are all orthopedic tests that confirm CTS.
• Palpation typically reveals posterior-lateral radial head subluxation.
Treatment:
• Ice, rest, adjustments most effective
• Eliminate or reduce the troublesome activity
• Elbow brace may be helpful if you must perform an aggravating activity. Brace acts as a secondary insertion site for musculature to decrease stress on its primary insertion site at the elbow.
Neurology of a joint
• Hilton's Law: Innervation of adjacent muscles and joint capsules related.
• Pre: Pre-test the joint with muscle testing. If weak or painful, and adjustment is warranted.
• Post: Post-test the joint, improvement of strength by 50% or >, and reduction in pain by 50%.
CCEP
• Certified Chiropractic Extremity Practitioner (post-graduate training in extremities)
Dr. Tim McRoberts carries his CCEP and specializes in extremity adjusting and sport related injuries.
