How To Treat Carpal Tunnel Syndrome Naturally
CFS is a true syndrome, not a single disease. As with other neurological syndromes (Parkinsonian, Guillain-Barre or carpal tunnel), the etio-pathogene-sis of CFS is diverse, probably multifactorial, with stress and systemic viral infections being the two commonest factors.3 However, irrespective of the precise pathogenic mechanism of CFS, fatigue symptoms are very similar across all CFS patients and are indistinguishable from the symptoms of fatigue experienced by patients with certain neuro
Apart from the high incidence of carpal tunnel syndrome, a sensorimotor polyneuropathy also occurs in hypothy-roidism. Sensory symptoms dominate the clinical picture and include painful dysesthesiae and lancinating pains in hands and feet. Usually, there is glove and stocking sensory loss, and occasionally distal weakness and wasting may be seen. The neuropathy tends to improve with thyroxine replacement therapy.
When pain is refractory to pharmacologic treatment, peripheral nerve blockade may be an option (Raj 1996). Somatic nerve blocks are used in patients with intractable pain, generally from cancerous invasion of parts of the body, including the nervous system. At times, these blocks are employed in peripheral nerve pain, sciatica, and carpal tunnel syndrome. In addition, peripheral nerve blocks are employed to provide analgesia during localized surgery so that the patient can avoid general anesthesia.
Carpal Tunnel Syndrome Carpal tunnel syndrome (CTS) is one of the most commonly encountered neuropathies in clinical practice and is described as an uncomfortable condition of the wrist and hand that is precipitated by repeated flexion and extension of the wrist causing increased pressure on the median nerve. Although CTS is commonly considered a condition of repetitive movement that may be related to particular occupations, it is also associated with medical conditions including diabetes, rheumatologic and thyroid disorders. CTS symptoms include pain that may radiate up the forearm, numbness, tingling, and reduced sensation in the hand and wrist and the symptoms often worsen at night or after use of the hand. The symptoms usually begin in the dominant hand, although in more than half the cases, the disorder is bilateral. Because carpal tunnel syndrome is usually treated surgically, little is known about its natural history. In one clinical study which followed 12 patients with CTS...
Carpal tunnel syndrome with capsular pattern (external rotation abduction internal rotation) Epicondylar pain and epicondylar tenderness and pain on resisted extension of the wrist Epicondylar pain and epicondylar tenderness and pain on resisted flexion of the wrist Pain over the radial styloid and tender swelling of the first extensor of the wrist compartment and either
This study found functional improvements in the OA patients comparable to those demonstrated in the previous study and a significant improvement in the pain and function subscales of the WOMAC measure were also noticed. In those patients with elbow or wrist pain, improvements were noticed in muscular endurance and in pain perception, but not the other outcome measures. The researchers concluded that the use of a CFA cream in patients with joint disease may be useful for enhancing the potential for exercise training in this population, and may thus be a useful adjunct to other treatments such as physiotherapy. Further research is needed to determine the impact of menthol in such a cream.
Occupational therapy incorporates a variety of pain management strategies to promote participation and quality of life
Chris, a 48-year-old truck driver, has a history of ulnar neuropathy and generalized wrist pain. He is now presenting with Carpal Tunnel Syndrome symptoms. You determine the need for Occupational Therapy (OT) evaluation and intervention (see Occupational Therapy Referral form - Fig. 15.2). In addition to referring to OT for wrist cock-up splints bilaterally, iontophoresis, and therapeutic exercise, it would be appropriate to request 4. The answer is C. Due to the symptoms of ulnar neuropathy and now carpal tunnel syndrome, it is expected that splints, iontophoresis, and therapeutic exercise will be beneficial to the client. Beyond this, the benefits ofmyofascial release have not been demonstrated to be effective. Relaxation may be beneficial, but the intervention most likely to bring about the needed work and lifestyle modifications would be an ergonomic evaluation. Through an ergonomic evaluation, Chris' sitting and reach in the semi-truck, along with his daily
Similarly, nerve conduction studies can objectively establish the presence of nerve compression in conditions such as carpal tunnel syndrome, tarsal tunnel syndrome, and ulnar nerve entrapment. Reciprocally, nerve conduction studies can exclude radial nerve entrapment as a differential diagnosis of lateral epicondylalgia of the elbow.50 In these conditions, although the mechanism by Particularly with respect to the carpal tunnel, abnormal conduction velocities occur in asymptomatic indivi-duals.55,56 Consequently, nerve conduction studies carry a substantial and annoying false-positive rate. Although only a minority of normal individuals exhibit abnormal conduction velocities, these individuals outnumber patients with pain ostensibly due to carpal tunnel syndrome. Consequently, in patients with suspected carpal tunnel syndrome, investigators cannot be certain whether the abnormal conduction velocities they detect are due to disease or are an incidental (false-positive) finding....
First and foremost, when obtaining the history from a pain patient, it is essential to listen to the patient. Successful clinicians are the ones who let their patients tell them about their symptoms. For example, when a patient complains of pain in the calves after walking a short distance, this could be a clue toward the diagnosis of peripheral vascular disease or lumbar spinal stenosis. When a patient complains of pain in one or both wrists especially while typing on a keyboard, it could be secondary to the diagnosis of carpal tunnel syndrome. A patient describing a sharp shooting pain starting in the low back area, with radiation to the distal lower extremity, might be suffering from S1 radiculopathy. However, in light of the current health-care environment it is also very important to manage time efficiently. Hence, asking focused questions will guide the process in a productive way.
These activities, if harmful, ought to be reduced so that the patient's relative activity is reduced to allow healing. Patient education is helpful to effect these behavior changes. If it is possible, the patient may arrange with co-workers or family members to decrease these activities temporarily. For example, a college professor presents with wrist pain. He works on the computer 8 h per day while at work. He is not in the position to reduce this time. However, the interview reveals that when he comes home, he spends an additional 6 h per night on a hobby that involves use of the computer. In this situation, if the patient can reduce his hobby time by 4 h, he will still be able to work and still obtain a relative decrease in repetitive wrist activity level.
An implicit assumption in CRPS treatment algorithms is that the precipitating or maintaining factors will be removed, or at least minimized. Unfortunately, there are no epidemiological data regarding this aspect of the condition. It could be argued that the Olmsted County study showed a high rate of spontaneous recovery because the underlying pathology was treated, without addressing the CRPS component. Clearly, more attention needs to be paid to this aspect of the problem. This author has seen patients who have not responded to conventional treatment of CRPS but who have recovered when an underlying problem was successfully treated. One case was referred after her insurance company declined further treatment after 49 stellate ganglion blocks. It was clear that she had carpal tunnel involvement, and she recovered after a surgeon could be prevailed upon to operate in the face of severe CRPS.
Neuropathic pain can arise from a number of sources (see Table 8-13). AS and C fibers are neurons responsible for mediation of pain (see Chapter 2, Sensory Pathways of Pain and Acute Versus Chronic Pain, of this book). Processes that may aggravate the pain-relaying AS and C fibers include nerve impingement (e.g., carpal tunnel syndrome, tumor impingement on brachial or lumbar plexus, disk herniation compressing adjacent nerve roots). Trigeminal neuralgia is attributed to localized compression of the trigeminal nerve by neighboring vascular structures. For these conditions, nerve conduction studies might reveal delays in the conduction velocities between the affected (painful) side and the unaffected side. The EMG might also reveal concomitant weakness when the motor components of the nerve are adversely affected. Computed tomography or magnetic resonance imaging may detect the affected nerves. Treatment is directed at relieving the underlying compression or nerve irritation (e.g.,...
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