COMPLETE RESOLUTION OF CARPAL TUNNEL SYNDROME AFTER RELIEVING THE ‘FIRST CRUSH’ IN ‘DOUBLE CRUSH SYNDROME’ BY IMPROVING THE CERVICAL SPINE POSTURE: A CBP® CASE REPORT
Main Article Content
Keywords
Carpal Tunnel Syndrome; Cervical Kyphosis; Double Crush Syndrome
Abstract
Objective: To discuss a case where complete resolution of carpal tunnel syndrome occurred following improvement in cervical spine lordosis and reduction of a lateral head translation posture.
Clinical Features: A 29-year old male had previously diagnosed carpal tunnel syndrome. Radiographic assessment showed an upper cervical spine kyphosis and a lateral head translation posture.
Intervention and Outcome: Treatment was aimed at restoring the cervical spine posture by use of Chiropractic BioPhysics® methods. Spinal manipulative therapy, mirror image® corrective exercises, and cervical extension traction methods were employed over a 13-week period. Thirty-three in-office treatment sessions as well as a daily home rehabilitation routine resulted in the structural improvement in cervical spine lordosis and a reduction in lateral head translation. This coincided with a complete resolution of carpal tunnel symptoms, including neck and upper extremity pains as well as bilateral hand numbness. The patient had a dramatic improvement in quality of life as measured on the SF-26 health questionnaire.
Conclusion: Biomechanically, a deviated cervical spine posture lengthens the spinal canal and exerts pathologic stresses onto the cord and nerves; consequently, further nerve irritation via upper extremity positions/movements may elicit outright neurologic symptoms consistent with carpal tunnel and related syndromes. We suggest treatment for carpal tunnel syndrome to be aimed at restoring normal cervical spine alignment as to remove the ‘first crush’ in this double crush syndrome. Further, routine assessment by radiography is recommended as a standard screening protocol for this disorder as it may offer a definitive etiology.
Downloads
References
2. American Academy of Orthopaedic Surgeons. Management of carpal tunnel syndrome. Evidence-based clinical practice guideline. 2016. [Available at: [https://www.aaos.org/uploadedFiles/PreProduction/Quality/Guidelines_and _Reviews/guidelines/CTS%20CPG_2.29.16.pdf]
3. Breig A. Biomechanics of the central nervous system. Stockholm, Sweden; Almqvist & Wiksell International, 1960
4. Breig A. Adverse mechanical tension in the central nervous system. Relief by functional neurosurgery. Stockholm, Sweden; Almqvist & Wiksell International, 1978
5. Wickstrom BM, Oakley PA, Harrison DE. Non-surgical relief of cervical radiculopathy through reduction of forward head posture and restoration of cervical lordosis: a case report. J Phys Ther Sci 2017;29:1472-1474
6. Moustafa IM, Diab AAM, Hegazy FA, et al. Does rehabilitation of cervical lordosis influence sagittal cervical spine flexion extension kinematics in cervical spondylotic radiculopathy subjects? J Back Musculoskelet Rehabil 2017;30:937-941
7. Moustafa IM, Diab AA, Taha S, et al. Addition of a sagittal cervical posture corrective orthotic device to a multimodal rehabilitation program improves short- and long-term outcomes in patients with discogenic cervical radiculopathy. Arch Phys Med Rehabil 2016;97:2034-2044
8. Harrison DE, Harrison DD, Cailliet R, et al. Cobb method or Harrison posterior tangent method: which to choose for lateral cervical radiographic analysis. Spine 2000;25:2072-2078
9. Harrison DE, Holland B, Harrison DD, et al. Further reliability analysis of the Harrison radiographic line drawing methods: Crossed ICCs for lateral posterior tangents and AP Modified-Riser Ferguson. J Manipulative Physiol Ther 2002;25:93-98
10. Harrison DE, Harrison DD, Colloca CJ, et al. Repeatability over time of posture, radiograph positioning, and radiograph line drawing: An analysis of six control groups. J Manipulative Physiol Ther 2003;26:87-98
11. Harrison DD, Harrison DE, Janik TJ, et al. Modeling of the sagittal cervical spine as a method to discriminate hypolordosis. Results of elliptical and circular modeling in 72 asymptomatic subjects, 52 acute neck pain subjects, and 70 chronic neck pain subjects. Spine 2004;29:2485-2492
12. McAviney J, Schulz D, Bock R, et al. Determining the relationship between cervical lordosis and neck complaints. J Manipulative Physiol Ther 2005;28:187-193
13. Oakley PA, Harrison DD, Harrison DE, et al. Evidence-based protocol for structural rehabilitation of the spine and posture: review of clinical biomechanics of posture (CBP®) publications. J Can Chiropr Assoc 2005;49:270-296
14. Harrison DE, Harrison DD, Hass JW. Structural rehabilitation of the cervical spine. Evanston, WY: Harrison CBP® Seminars, Inc., 2002
15. Harrison DD, Janik TJ, Harrison GR, et al. Chiropractic Biophysics technique: a linear algebra approach to posture in chiropractic. J Manipulative Physiol Ther 1996;19:525-535
16. Harrison DE, Harrison DD, Betz J et al. Increasing the cervical lordosis with seated combined extension- compression and transverse load cervical traction with cervical manipulation: Nonrandomized clinical control trial. J Manipulative Physiol Ther 2003;26:139-151
17. Moustafa IM, Diab AA, Harrison DE. The effect of normalizing the sagittal cervical configuration on dizziness, neck pain, and cervicocephalic kinesthetic sensibility: a 1-year randomized controlled study. Eur J Phys Rehabil Med 2017;53:57-71
18) Harrison DE, Cailliet R, Harrison DD, et al. A new 3-point bending traction method for restoring cervical lordosis and cervical manipulation: A nonrandomized clinical controlled trial. Arch Phys Med Rehab 2002;83:447-453
19. Upton AR, McComas AJ. The double crush in nerve entrapment syndromes. Lancet 1973;2:359-362
20. Massey EW, Riley TL, Pleet AB. Coexistent carpal tunnel syndrome and cervical radiculopathy (double crush syndrome). South Med J 1981;74:957-959
21. Harrison DE, Cailliet R, Harrison DD et al. A review of biomechanics of the central nervous system--part II: spinal cord strains from postural loads. J Manipulative Physiol Ther 1999;22:322-332
22. Harrison DE, Cailliet R, Harrison DD et al. A review of biomechanics of the central nervous system--Part III: spinal cord stresses from postural loads and their neurologic effects. J Manipulative Physiol Ther 1999;22:399-410
23. Oakley PA, Harrison DE. Radiogenic cancer risks from chiropractic x-rays are zero: 10 reasons to take routine radiographs in clinical practice. Annals of Vert Sublux Res 2018;March 10:48-56
24. Oakley PA, Harrison DE. Radiophobia: 7 reasons why radiography used in spine and posture rehabilitation should not be feared or avoided. Dose Response 2018;Jun 27;16(2):1559325818781445
25. Oakley PA, Cuttler JM, Harrison DE. X-ray imaging is essential for contemporary chiropractic and manual therapy spinal rehabilitation: radiography increases benefits and reduces risks. Dose Response 2018 Jun 19;16(2):1559325818781437
