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Case Studies: Carpal Tunnel Syndrome

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Carpal Tunnel Syndrome (CTS) results from impingement of the Median Nerve in the arm. This nerve runs from the neck, down the arm, through bones in the wrist (carpal tunnel), to supply the hand and thumb. Irritation to this nerve often results in numbness, tingling, and pain in the hand and thumb, loss of grip strength in the hand and thumb, and pain / numbness radiating from the neck and arm.


In a review of medically confirmed carpal tunnel syndrome cases, it was discovered that the majority of patients examined also had concurrent problems with the cervical spine.1 Because nerve roots from the cervical spine form the median nerve in the arm, it has been suggested that cervical problems can contribute to the onset of CTS.2-18 Many of these patients do not respond to conservative and/or surgical treatment directed solely at the wrist. Because cervical nerve irritation and/or compression renders the lower nerves in the wrist more susceptible to injury, it is essential to properly correct the cervical problem first if the wrist condition is to fully resolve.

The purpose of IUCCA upper cervical care is to correct cervical spine mechanics that are irritating spinal cord tracts and nerve roots that extend to the wrist. A similar phenomenon can occur with Thoracic Outlet Syndrome (TOS) and cervical radiculopathy (tingling, pain down the arms). While many carpal tunnel sufferers recall specific traumas such as head injuries, auto accidents or falls, which could have injured their cervical spines, some do not. An upper cervical examination utilizing Laser-aligned Radiography and Digital Infrared Imaging is necessary in each individual's case to assess whether an upper cervical injury is present and whether benefit from upper cervical care can be achieved.


Carpal Tunnel Case Studies

1. Hurst LC, Weissberg D, Carroll RE. The relationship of the double crush to carpal tunnel syndrome (an analysis of 1000 cases of carpal tunnel syndrome). J Hand Surg 1985 Jun; 10(2): 202-4.
2. Ide M, Ide J, Yamaga M. Symptoms and signs of irritation of the brachial plexus in whiplash injuries. J Bone Joint Surg Br 2001 Mar; 83(2): 226-9.
3. Roquer J, Herraiz J, Maso E. Carpal tunnel syndrome and cervical whiplash. Neurologia 1988 Sep-Oct; 3(5): 202-3.
4. Critelli N. Head injury-cervical strain-carpal tunnel syndrome-a videotaped evidence deposition of plaintiff's neurosurgeon-direct and cross-examination. Med Trial Tech Q 1982 Summer; 29(1): 114-36.
5. Niwa H, Yanagi T, Hakusui S. Double crush syndrome in patients with cervical spondylosis or ossification of posterior longitudinal ligament-a clinicophysiological study. Rinsho Shinkeigaku 1994 Sep; 34(9): 870-6.
6. Valente R, Gibson H. Chiropractic manipulation in carpal tunnel syndrome. J Manipulative Physiol Ther 1994 May; 17(4): 246-9.
7. Murray-Leslie CF, Wright V. Carpal tunnel syndrome, humeral epicondylitis, and the cervical spine: a study of clinical and dimensional relations. Br Med J 1976 Jun 12; 1(6023): 1439-42.
8. Zahir KS, Zahir FS, Thomas JG. The double-crush phenomenon-an unusual presentation and literature review. Conn Med 1999 Sep; 63(9): 535-8.
9. Morgan G, Wilbourn AJ. Cervical radiculopathy and coexisting distal entrapment neuropathies: double-crush syndromes? Neurology 1998 Jun; 50(1): 78-83.
10. Herczeg E, Otto A, Vass A. Significance of double crush in carpal tunnel syndrome. Handchir Mikrochir Plast Chir 1997 May; 29(3): 144-6.
11. Pierre-Jerome C, Bekkelund SI. Magnetic resonance assessment of the double-crush phenomenon in patients with carpal tunnel syndrome: a bilateral quantitative study. Scand J Plast Reconstr Surg. 2003: 37(1):46-53.
12. Kuntzer T. Carpal tunnel syndrome in 100 patients: sensitivity, specificity of multi-neurophysiological procedures and estimation of axonal loss of motor, sensory and sympathetic median nerve fibers. J Neurol Sci 1994 Dec 20; 127(2): 221-9.
13. Mariano KA, McDougle MA, Tanksley GW. Double crush syndrome: chiropractic care of an entrapment neuropathy. J Manipulative Physiol Ther 1991 May; 14(4): 262-5.
14. Wood VE, Biondi J. Double-crush nerve compression in thoracic-outlet syndrome. J Bone Joint Surg Am 1990 Jan; 72(1): 85-7.
15. Narakas AO. The role of thoracic outlet syndrome in the double crush syndrome. Ann Chir Main Memb Super 1990; 9(5): 331-40.
16. Osterman AL. The double crush syndrome. Orthop Clin North Am 1988 Jan; 19(1): 147-55.
17. Massey EW, Riley TL, Pleet AB. Coexistent carpal tunnel syndrome and cervical radiculopathy (double crush syndrome). South med J 1981 Aug; 74(8): 957-9.
18. Upton AR, McComas AJ. The double crush in nerve entrapment syndromes. Lancet 1973 Aug 18; 2(7825): 359-62.

This web site is designed for educational purposes only and is not engaged in rendering health care advice. The information provided through this website should not be used for diagnosing or treating a health problem or disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, you should consult a health care provider. The authors, editors, producers, sponsors, and contributors shall have no liability, obligation or responsibility to any person or entity for any loss, damage, or adverse consequence alleged to have happened directly or indirectly as a consequence of this material.



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