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Carpal Tunnel Syndrome; Cervical Kyphosis; Double Crush Syndrome
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.
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