This page has an overview of our research findings from our book & Two articles on the treatment (from both an economic and massage therapy treatment perspective).

Overview of Research Findings as presented in the Book:

Carpal Tunnel Syndrome 90% Misdiagnosed:

For the Patient & Provider

Based on Clinical Research

Second Edition

Angela Rahn, MPT

Roger S. Rahn, MT, DC

Contents Page

What is Carpal Tunnel Syndrome 12

Dr. Rahn’s Perspective 23

Dr. Rahn’s Thoughts on Chiropractic 26

Why Most Carpal Tunnel Syndrome 30

Diagnoses Are Inaccurate

(this section is written primarily for

health care providers)

Making a Correct Diagnosis 36

(with symptom survey)

Treatment Protocol for Non-Surgical 42

Neurovascular Decompression

Satisfaction Guarantee 57

Research Supporting Our Treatment 59

Protocol (this section is written

primarily for health care providers)

Appendices:

A: Ergonomic Considerations

B: Stress Reduction Considerations

C: Dr. Rahn on Nutrition

D: Technique for Neck Pain and Headache

E: Technique Applied to Leg Pain

F: Dr. Rahn’s Hand Exam Form

G: Equipment

H: Carpal Tunnel Height Measuring Procedure

I: Works Cited

J: Stretches and Exercises for TOS and CTS

K: About Dr. Rahn

Abstract: 100 patients were treated (with 155 peripheral nerve entrapment presentations, compression of the nerves outside the spinal cord) including: 85 with hand symptoms, 14 with sciatica and 1 with femoral nerve compression. Physical examination screening determined if hand pain originated in the spine, shoulder or hand without costly radiological testing.

Eighty-five of the patients completely resolved: 86% of which required an average of 3.2 treatments and 14% of which required an average of 16.5 treatments. Five patients require maintenance care @ 1 treatment every 1-3 weeks. And, ten patients are permanent and stationary (maximally improved). Regarding the fifteen patients that did not resolve 100%, they rate their reduction in symptoms at about 60%.

Half of all patients have been tracked for over one year with only 10% having mild flair ups within 2-6 months and this re-occurrence was successfully resolved with an average of 2 treatments.

All hand patients had the primary cause of their presentation in the shoulder.

Treatments take 30-45 minutes. The cost per treatment is $52 (@ CA Worker’s Comp). 90% of the treatment time is focused on the shoulder. The two groups treated averaged $166.40 & $858.00 to completely resolve, or reach maximally improved. Re-occurrence and comparative cost analysis included.

This highly effective, inexpensive treatment incorporates massage, physical therapy and joint manipulation (chiropractic or non-thrust). Experienced massage therapists successfully duplicate treatment after 4, 4-hour seminars.

Graph of the Percentage of Patients Needing Treatment (Tx) v. the Percentage of Patients Resolved over time

This time line is segmented where certain group’s resolved their care. Seven patients resolved ‘initially’ with only one treatment. Eighty-five patients resolved at an average of 3.2 treatments. Ten additional patients resolved before their 17^th treatment. And, 5 patients continue to require maintenance care.

Treatment Cost Per Year

The ‘long term + maintenance’ was calculated where the average patient would receive 16.5 treatments in the first 3 months. For the remainder of the year (9 months) they would receive an average of 2 treatments / month for 9 months = 18 treatments. The initial 16.5 txs + 18 additional txs = 35 treatments / year, or $1820.00 / year.

Additional cost references:

By comparison, the medical costs and loss of productivity due to CTS add up to $29,000 per patient, according to a report by physicians at the Harvard Medical School (32). The same report estimated that musculo-skeletal injuries in the United States alone total $20 billion per year (32). Another review estimated that half of all Americans will have occupational injuries by the year 2000 (33).

The cost of treatment in our study also compares favorably to typical workers’ compensation claim costs as illustrated in the graph below.

Additional cost references:

Medical costs and loss of productivity (due to CTS) = $29,000 and US musculo-skeletal injuries = $20 B / year (32).
By the year 2000 50% of Americans will have occupational injuries…(33).

Cost Comparison in Dollars / Year to Treat (CTS / Peripheral Nerve Entrapment Syndrome).

* Worker’s comp statistics, for the federal workforce, from the US Department of Labor, Office of Worker’s Compensation Programs (OWCP) from October 1, 1993 through September 30, 1994 (8). A total of 185,927 claims with diagnoses of (UED) upper extremity disorder (7). The average number of workdays lost for CTS was 84; and, Dr. Rahn’s patients lost a total number of workdays (average / patient / year) of 11.6*.

Regarding Severity of Presentations:

Initially, 65% of patients were (subjectively and objectively) rated at a severity of ‘Acute’. 6% were rated as mild, 14% as low to moderate and 15% as moderate.

*Workdays Missed:

Three patients were rated at total temporary disability and were out of work for a full year, (patients ‘49’, ‘93’ and ‘100’). The first 2 patients underwent vocational rehab and returned to full time employment where one “100’ is still on total disability. Patient ‘88’ missed 7 days and patient ‘89’ missed 14 days.

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Two Articles on Chiropractic Economics & Massage as they relate to Our Treatment-

Article on Chiropractic Economics & Our Treatment-

Chiropractors Effectively Treat Carpal Tunnel Syndrome! By Roger S. Rahn, DC & Angela Rahn MPT

THE OVERVIEW:

Carpal Tunnel Syndrome (CTS) is the biggest, toughest work comp nut to crack! And, chiropractic now has an effective, reproducible treatment (as clinically proven and demonstrated in several offices).

Let us start with a clear understanding of the magnitude of CTS. OSHA has stated the following:

v CTS is the #1 disability reported by insurance companies.

v Repetitive Stress Injuries (RSI’s) like CTS are the nation’s leading workplace health cost amounting to 62% of all work comp claims (costing $15-20 B in medical costs and lost work time). Back injuries were the second most common problem. (And, half of all CTS cases lost over 30 days of work according to Linda Garrison, Bureau of Labor and Statistics economist.)

v CTS is the leading RSI (or cumulative trauma disorder, CTD) accounting for 1/3^rd of all cases. The number of reported cases has increased 8,000% from 23,800 in 1972 to 2 million in 1995.

v The average lifetime cost to treat a patient with CTS (medical costs and lost work time) is $30,000 (also quoted by NIH).

Let us take a moment to review the definition of CTS. This problem is compression of the median nerve in the carpal tunnel (wrist). Compression is usually related to inflammation or edema in the wrist. Usually, health care providers attribute the problem to repetitive stress syndrome, such as the increased use of computer keyboards. However, the authors conducted research that clearly shows that the most common cause of hand swelling is compression of the neuro-vascular bundle at the front of the shoulder (Thoracic Outlet Syndrome or TOS).

TOS decreases the circulation and consequently, dependent edema (inflammation pulled down by gravity) settles in the forearm and hand. This is the same mechanism as the weight of a pregnant woman’s womb (and stabilizing muscle spasm) compressing vessels entering the pelvis resulting in dependent edema at the ankles.

To finish painting the picture, medications and surgery do decrease pressure on the median nerve (the surgery cuts the flexor retinaculum & removes the bottleneck of inflammation); however, the genesis of the inflammation was the shoulder!

The US Department of Labor & Statistics talks about patients needing an average of $8,000 per year to treat a patient. Surgical journals talk about:

v A long time to maximal improvement (9.8 months),

v 30% of all patients complain of poor to fair strength & scar discomfort,

v 57% of all patients having a recurrence of symptoms after 2 years. And, this is after many workers are rehabilitated into a job designed to eliminate aggravation of the problem.

Interestingly, we also found research that states ‘over 1/3^rd of the population under the age of 30 have asymptomatic disc bulges’!

OK, now to the crux of the problem. Our last paragraph shows that we can no longer tell a patient that, “The disc bulge in the MRI proves the hand problem comes from the neck”. The authors have developed a symptom survey to help patients understand whether hand problems could be caused by the neck, shoulder or hand itself. The survey is available on the author’s website www.DrRogerSRahn.com. Of course, this self-evaluation is a tool- where the appropriate health care provider should provide an accurate follow up diagnosis.

If we look at CTS as a problem caused from the shoulder, we then ask, “Why couldn’t the medical doctors diagnose this?” Because, TOS caused by muscle spasm at the front of the shoulder does not show up on X-ray or MRI. Wow.

RESEARCH OVERVIEW:

Abstract: 100 patients were treated (155 peripheral nerve entrapment presentations or compression of the nerves outside the spinal cord) including: 85 with hand symptoms, 14 with sciatica and 1 with femoral nerve compression. Physical examination determined if hand pain originated in the spine, shoulder or hand without costly radiological testing.

Eighty-five of the patients completely resolved: 86% of which required an average of 3.2 treatments and 14% of which required an average of 16.5 treatments. Five patients require maintenance care @ 1 treatment every 1-3 weeks. Ten patients are permanent and stationary (maximally improved). Regarding the fifteen patients that did not experience 100% resolution, they rated their reduction in symptoms at about 60%.

Half of all patients have been tracked for over one year with only 10% having mild flair ups within 2-6 months and this re-occurrence was successfully resolved with an average of 2 treatments.

All hand patients had the primary cause of their presentation in the shoulder.

Treatments take 30-45 minutes. The cost per treatment is $52 (@ CA Worker’s Comp). 90% of the treatment time is focused on the shoulder. The two groups treated averaged $166.40 & $858.00 to completely resolve, or reach maximally improved. Reoccurrence and comparative cost analysis is included.

Graph of the Percentage of Patients Needing Treatment (Tx) v. the Percentage of Patients Resolved over time

This time line is segmented where certain groups resolved their care. Seven patients resolved ‘initially’ with only one treatment. Eighty-five patients resolved at an average of 3.2 treatments. Ten additional patients resolved before their 17^th treatment and 5 patients continue to require maintenance care.

Treatment Cost Per Year

Additional cost references:

· Medical costs and loss of productivity (due to CTS) = $29,000 and US musculo-skeletal injuries = $20 B / year (32).

· By the year 2000 50% of Americans will have occupational injuries…(33)

Cost Comparison in Dollars / Year

to Treat (CTS / Peripheral Nerve Entrapment Syndrome).

* Worker’s comp statistics, for the federal workforce, from the US Department of Labor, Office of Worker’s Compensation Programs (OWCP) from October 1, 1993 through September 30, 1994 (8). A total of 185,927 claims with diagnoses of (UED) upper extremity disorder (7). The average number of workdays lost for CTS was 84 and Dr. Rahn’s patients lost a total number of workdays (average / patient / year) of 11.6*.

Regarding Severity of Presentations:

Initially, 65% of patients were (subjectively and objectively) rated at a severity of ‘Acute’. 6% were rated as mild, 14% as low to moderate and 15% as moderate.

*Workdays Missed:

Three patients were rated at total temporary disability and were out of work for a full year, (patients ‘49’, ‘93’ and ‘100’). The first 2 patients underwent vocational rehab and returned to full time employment but one “100’ is still on total disability. Patient ‘88’ missed 7 days and patient ‘89’ missed 14 days.

ASSESSMENT:

According to the US Bureau of Labor and Statistics, the incidence rate is defined as (# of injuries & illnesses x 200,000) / Employee Hours Worked, (where 200,000 represents 100 workers working 40 hours / week for 50 weeks in a year).

For 2004 the incidence rate for non-fatal occupational injuries & illnesses involving days away from work (in private industry regarding 1,259,320 total cases) totals 141.3 . Of this 50.2 (over 1/3^rd of all cases) were trunk (back and shoulder) related, 32.6 were UEDs (upper extremity disorders) and 30.2 LEDs (lower extremity disorders). The neck represents only a 2.4 incidence rate. If we see chiropractic as traditionally trunk, well back oriented, our scope of treatment could double to include extremity disorders.

I know these numbers are not limited to musculoskeletal disorders; however, the etiology of CTS is currently debated. Also, we believe that the TOS creates swelling in the forearm and hand which is a major contributing factor to other inflammatory problems such as tendonitis and trigger finger! Another category, pain and soreness, also has inflammation as a basic cause. Our research has shown improvement in all the above categories of arm / hand problems when the shoulder was treated first.

The same source lists for the year 2001, 42,679 cases of back pain where 27,894 are attributed to musculoskeletal disorders. Obviously, chiropractors should be treating over half of all these work comp back pain presentations.

Also, in the musculoskeletal category, we have 26,522 cases of CTS, 23,601 connective tissue problems, and 12,131 cases of general soreness and pain. To start, our number of CTS cases almost equals the number of back pain cases. Then, we associate the other connective tissue problems, tendonitis and general pain cases (many are secondary to TOS) and the potential number of UED cases greatly exceeds the number of back pain cases.

Summary:

Carpal tunnel syndrome has been shown to result from TOS. Associated problems from inflammation of tendons and ligaments as well as general soreness and pain oftentimes results from TOS. The group, whether just accepted CTS cases or CTS and associated inflammatory problems is as big or bigger than the number of back and neck cases.

The above research resolved most CTS cases in fewer than 6 treatments. The average cost to treat CTS in the US is about $8,000 where the above research cost is under $500. The cost reduction is 90%; also, the recurrence of hand symptoms with the described treatment is small.

Chiropractic offices, supervising a massage therapist (or having the DC provide simple trigger point therapy to pec minor initially) have been able to reproduce the above results. Of course, the chiropractor and therapist must both be versed in the needed soft tissue techniques. The DC would provide CMT to the cervical spine & glenohumeral joint. Other considerations would include ergonomics & stress reduction. The bottom line is that patients seeking relief from chronic, debilitating hand problems will seek care from chiropractors to avoid ongoing symptoms and surgery.

The overall work comp market potential is now double the number of cases (because we now target different cases such as CTS). By diagnosing hand problems as TOS (peripheral soft tissue compression of nerves and vessels) – undiagnosed by doctors because the problem cannot be medically imaged – and combining joint manipulation with specific therapeutic massage, ergonomic considerations and home care, chiropractors can move forward with confidence as the premier health care providers for carpal tunnel syndrome and related presentations!

Additionally, similar peripheral compression syndromes (such as pyriformis syndrome causing sciatica, sub-occipital myospasm on the occipital nerves causing headache and compression of the facial nerve causing facial complaints) have been treated with the same success.

Reductions in the number of treatments we are allowed is less of a problem when we achieve dramatic results more quickly. Mastering treatment of these problems will attract patients, employers and insurance carriers simply by word of mouth! Lastly, the patient volume will not decrease as appropriately trained massage therapists are utilized.

Yes, joint manipulation is powerful in reducing myospasm; and, at times the therapeutic massage helps both the ease of the adjustment and how long the adjustment lasts. Lastly, these advanced soft tissue techniques reduce spasm, fibrous tissue adhesions and edema. Chiropractic will now spearhead this combination of joint and soft tissue manipulation, properly diagnosing peripheral entrapment and effectively resolving problems that have eluded medical care!

Article on Massage Therapy & Our Treatment-

Massage Finds New Cause & Cure For Carpal Tunnel!

Clinical Study of 100 Patients by Angela Rahn MPT & Roger Rahn MT, DC

Introduction:

My name is Roger & in my experience as a massage therapist and chiropractor, I have met many patients with either a diagnosis of carpal tunnel syndrome (CTS) or the scars from the CTS surgery. In either case, these people had weakness and numbness in their hands. Often, they were unconcerned because this was ‘normal’ for them and they did not experience pain. I had to explain to them that the longer and more severe the hand weakness, the more likely they were to develop a non-reversible weakness (that can result in disability). This gets their attention!

Carpal Tunnel Syndrome is usually regarded as compression of the (median) nerve at the base of the palm of the hand. Typical surgical treatment cuts the (flexor retinaculum) ligament thereby decreasing pressure on the nerve. The nerve compression can cause muscle wasting and weakness (as well as numbness and tingling). What if inflammation in the carpal tunnel is the culprit & this inflammation does not originate in the hand?

It was my significant experience as a massage therapist and massage instructor that prompted me to look for muscle spasm along the length of the nerves from the neck to the hand. The main cause of carpal tunnel syndrome (CTS) and other ongoing pain problems is compression of the nerves from MUSCLE SPASM. This was proven in a recent clinical study of 100 patients. Who is going to treat muscle spasm? Most of the physical therapists and chiropractors I know do not want to work as had as we do! We are the specialists, and we will resolve the problem!

Using a treatment of ‘TRIGGER POINT’ release (combined with a variation of trigger point therapy to break up fibrous adhesions), followed by ‘CIRCULATORY MASSAGE / MILKING’ most patients with hand problems (pain, numbness & weakness), resolved in under 6 treatments!

The New ‘Cause’:

The initial cause of carpal tunnel is usually muscle spasm at the front of the shoulder, pectoralis minor as shown in the illustration below. This muscle will become ‘constantly’ tight with work that holds the arm out in front of you (such as being ergonomically incorrect while working at a computer). The blood and lymph vessels to the arm, as well as the nerves to the arm become compressed below pectoralis minor.

Another, less common problem is spasm at the front of the lower neck (anterior scalene and SCM) – also compressing nerves leading to the arm. Of course, I would have to rule out the cause of nerve compression from herniated discs in the neck. Here is where I discovered that a previous diagnosis of disc problems (even proven on MRI) would resolve with the ‘bodywork’ treatment to the front of the shoulder and arm. Why & how? Doctors attribute nerve problems to the disc bulge because they cannot see compression from muscle spasm (peripheral compression or compression outside the spinal column); however, recent studies show people have disc bulges WITHOUT symptoms! No wonder current results are so poor, we are not identifying the origin of the nerve compression.

Spasm in these locations (the front of the shoulder and neck) can compress both nerves and vessels (blood vessels and lymphatic vessels). Again, usually there is a long-term compression that does NOT cause pain. The pressure on nerves causes grip weakness (and atrophy at the base of the thumb). Also, pressure on vessels decreases circulation & gravity pulls the swelling down to the forearm & hand. This is the same mechanism in pregnant women where the weight of the womb on the pelvis (compressing the blood & lymph vessels) causes swelling in the ankles.

We now know WHERE the problem originates, but another question rears it’s ugly head. Why is carpal tunnel a relatively recent problem? Let us look back ‘BC’ (before computers). This CTS type of problem has increased 8,000% from 23,800 reported cases in 1972 to 2 million in 1995. This commonly accepted information is from the US Bureau of Labor & Statistics (with some following numbers from OSHA and the NIH). Most health care providers feel it is the actual keyboarding / typing that creates the problem. This is called Repetitive Stress Injury ‘RSI’ or Cumulative Trauma Disorder ‘CTD’.

Once again we have to move away from common thought. We feel that the position in front of the computer is STATIC as our work becomes more and more specialized. We are not lifting much; we are simply holding our arms up and forward, in a constant posture that creates spasm at the shoulder. This makes sense because the spasm occurs at the muscles that hold the arm up (anterior deltoid, pectoralis major and minor, as well as trapezius and SCM). Ergonomic programs help greatly; still, just something as simple and common as stress can combine with static posture to create spasm & foil the best treatment plan!

How big is the problem? OSHA says that RSI cost employers $20 billion in 1993 and that 2.73 million workers were affected. The indirect cost could be about $100 billion. Some feel that at one time or another over half of all workers ‘keyboarding’ will have hand symptoms. Also, half of all workers affected change their job within 30 months.

CTS comprises over 1/3^rd of all RSI. But, we feel that the shoulder problem creates inflammatory problems in the arm and hand that contribute to other ‘supposedly different’ problems such as tendonitis and trigger finger.

Sidebar- 3 Common Medical Misconceptions

v Why is it that doctors cannot diagnose this shoulder compression (also called Thoracic Outlet Syndrome or TOS)? Because, doctors do not usually feel (palpate) muscle spasm & spasm cannot be medically imaged on X-Ray or MRI.

v Prevailing thought is that a ‘disc bulge’ as seen on MRI proves that the disc is the cause of the medical complaint; however, studies have shown that over 1/3^rd of the population under the age of 30 have disc bulges without symptoms! A positive MRI proves nothing!

v An additional note, as we are talking about prevailing medical treatment, if a hand has damage to the ligaments (extrinsic CTS), the traditional ‘cock-up’ splint’ will flatten out the carpal tunnel and increase pressure on the affected nerve. The ‘cock-up’ extends the wrist (puts the hand back and up). We have developed a glove that maintains maximum carpal tunnel height (as measured with a micrometer).

This brings us to the big question of, “How do we determine exactly where the problem begins?” Below is a ‘Symptom Survey’ that helps patients and providers determine if the hand problem is from the neck, shoulder or hand itself.

Symptom Survey:

Important Disclaimer: While the massage therapist’s scope of practice may not include diagnosing (and informing) the patient of their problem(s), we ‘diagnose’ every time we find a spasm! Yes, your license may not include informing the client of a diagnosis; however, we still need to determine what is wrong so that we know where & how to treat.

Survey for the Neck:

· Does the pain seem to come from the neck (the center or midline where the spine is)? If yes, give yourself 10 points.

· Is the pain aggravated or does the pain occur: i) on the side opposite to the direction you move as you turn your head to the side, ii) when you bend your head forward, or iii) move your ear toward your shoulder while looking straight ahead? This pain may be from muscle spasm. If yes, give yourself 5 points.

· If someone else pushes gently on the top of your head while you are sitting, does the pain become sharp and shoot out from the middle of the neck to the shoulder or arm? If yes, give yourself 15 points.

· Have someone gently massage the tops of your shoulders while you lay on your back. If this reproduces your pain, subtract 5 points from your score.

If your neck score is over 20 points it is likely that you have a neck (spine) problem, which is usually pressure on a nerve root or a disc problem. This score warrants an exam by a health care provider because, if left untreated, you may suffer a loss of strength, sensation and range of motion. Permanent disability can result.

A score less than 20 points may simply be from muscle spasm and a massage therapist can take care of the problem. However, any persistent problem should be evaluated by the appropriate health care provider.

Survey for the shoulder:

· Press below the collarbone, move your fingertip from left to right, and feel from the center of the chest to the armpit. If you feel hard bumps (muscle spasm) and tenderness, give yourself 10 points. A health care provider would be looking for the muscle named ‘pectoralis minor.’

· Feel the pulse in your wrist with the index finger of the other hand (on the inside of the wrist toward the thumb side of the arm). If it is weak give yourself 10 points.

· If someone else can feel your wrist pulse while gently pulling the arm to the side, but the pulse strength changes, diminishes or disappears as they pull it back, give yourself 15 points.

· If the muscles around the shoulder are tender when pressed, or the shoulder is painful when moved, give yourself 10 points.

If your shoulder score is 20 points or higher, there is a good chance that you have thoracic outlet syndrome (TOS). It compresses the nerves and blood vessels in the front of the shoulder, which may cause swelling in the arm and hand. TOS can cause weakness, numbness, and/or pain in the hands.

A score less than 20 points may simply be from muscle spasm, and a massage therapist can take care of the problem. Again, any persistent problem should be evaluated by the appropriate health care provider.

Survey for the Hand (Carpal Tunnel Syndrome):

Place your hand flat with the palm down on the table. Press firmly on the high point of the wrist. To find this point, go to the midline of the arm, find where the wrist joint bends, and move 1 inch towards the fingers. If the wrist bones feel springy (move more than 1/8 inch) you probably have carpal tunnel syndrome! Dr. Rahn’s wrist brace and treatment protocol is definitely indicated.

Treatment:

After trigger point therapy to the front of the shoulder, pectoralis minor specifically, an appropriate health care provider may be utilized for joint mobilization to the neck and shoulder joint (glenohumeral joint). This usually prevents the pattern of spasm from returning, especially if stress reduction and ergonomic factors are reviewed.

HOT TOPIC – joint mobilization! I (Dr. Roger) have provided therapeutic massage since 1985. I know that we (massage therapists) have always pulled on hands, fingers, arms and legs- then applied a vibration or shaking movement. There is no problem resulting from this type of therapy, which does mobilize joints. After the muscles are relaxed, joint mobilization is usually very easy and can be accomplished without the traditional chiropractic ‘quick thrust’ beyond the normal / passive range of motion. Simply put, our treatment to the shoulder would not work without mobilizing the shoulder (gleno-humeral) joint because the pattern of spasm would come back! I learned this after a great deal of frustrated treatment! If the joint ‘restriction’, or overall pattern persists, then refer to a chiropractor or PT for a ‘hard’ adjustment. This is my considered opinion as a massage therapist and chiropractor of over 18 years. I believe we need to build bridges. Our office gets the ‘basket case patients’ after other providers have unsuccessfully treated for years; and, we achieve truly great results because of the combination of massage and chiropractic – and PT rehab! For the sake of the patients, cooperation is essential.

Also, after the spasm is reduced, and joint mobilization provided to the shoulder, a circulatory or milking massage is usually provided to reduce swelling in the forearm and hand. If there is compromise of the deep lymphatic system, such as following a radical mastectomy with removal of axillary lymph vessels, superficial lymphatic drainage should be utilized.

Chronic situations usually do not hurt. It is the sensation of the hand falling asleep at night, or weakness (as with difficulty opening a jar or dropping objects) that usually present. After considerable time has passed the hand pain may surface as an ‘end-stage’ nerve degeneration. So, many patients do not have pain; however, when we decompress the nerve and re-generation takes place, any sensation – including severe pain – may result. Obviously, the patient should be forewarned! Progress is measured not by pain, rather by an increase in grip strength:

v If the pain increases, but the spasm and swelling is reduced, then the pain is good (as in nerve regeneration).

v If the pain is accompanied by an increase in pec minor spasm and arm / hand edema, the situation is aggravated.

To summarize, a previous diagnosis of CTS does not tell you if the hand problem is from the neck, shoulder or hand itself. Yes, there may in fact be compression at the wrist, due to swelling; but is this swelling from the spasm at the front of the shoulder? The question is not if the hand is involved, rather, what part of the anatomy originally caused the hand problem.

Our research included 100 patients with hand problems. This could include pain, numbness, tingling or weakness. About 85% of the patients resolved in under 6 treatments. Some patients were quite advanced, and required months of care to regenerate damaged nerves, and repair the resulting atrophy. A few patients require ongoing care or maintenance. The reasons for ongoing care include: advanced problems, poor ergonomics and high stress levels. However, virtually ALL our patients recover to being basically pain free and have grip strength within normal limits. A clinical abstract and statistical analysis of treatment costs are available under “Research Overview” on the authors’ website.

Ergonomics play a critical role in preventing CTS and carpal tunnel from the shoulder. The absolute bare basics for office ergonomics are that the:

Ø shoulders should be down so that the joint (ligaments and bone) carry the weight of the arm – not the shoulder muscles

Ø elbows should be close to the sides of the body

Ø elbows should make a 90 degree angle or greater

Ø the forearm to hand should be straight (the hand should not tip up / back at the wrist).

The industrial ergonomic goals are the same where we want to limit the reach and try to keep the body in a ‘neutral’ position. Lastly, we can prevent the same hand numbness and weakness in therapists by, again, keeping the shoulders down, elbows close, and moving with the hips – not the shoulders. I imagine that I have a bolt holding my elbows to the sides of my body; and, the push comes from the movement of my body. We also want to reduce stress on the hands by reducing the oil (slippery surfaces are harder to work on and require more force), and changing our hand’s contact point (to the middle knuckles (PIPs), the knuckle between the small finger and hand (5^th MCP), finger tips, elbows and so on).

Conclusion:

We should do what we do best. We need to relieve shoulder spasm, then decrease arm and hand edema. Looking at professions in general, only the body worker routinely works hard enough to provide the treatment described. OK then, we know we will be the ones to finally resolve the insidious, the biggest worker’s comp claim, CTS (and other peripheral compression presentations).

Full References, Training DVD & Book may be reviewed at the author’s website: www.DrRogerSRahn.com

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