A relief maneuver in carpal tunnel syndrome

Abstract

We describe a maneuver that eases or abolishes paresthesias in carpal tunnel syndrome. With the affected hand palm up, the distal metacarpal heads are gently squeezed together; in some instances stretch of digits III and IV is also required. This maneuver may help in the clinical diagnosis of carpal tunnel syndrome, can be useful as a means of relieving symptoms, and provides the basis for the design of an innovative splint. Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy, with an incidence of 88-125 cases per 100,000 and a prevalence of 9.2% in women and 0.6% in men. 2,7 In the quest for a provocative test to aid in its diagnosis, we noticed that squeezing the distal heads of the metacarpal bones together had the opposite effect and actually relieved, when present, paresthesias and other positive symptoms of CTS. On the basis of this observation we developed a maneuver that we call the carpal tunnel syndrome relief maneuver (CTS-RM). In the basic maneuver, the affected hand is maintained with palm up and the distal heads of metacarpal bones (excluded the first) are gently squeezed inducing a slight adduction of digits II and V, so as to occlude the II and IV interdigital spaces (Fig. 1). When this is not sufficient to relieve symptoms, we turn the palm down and also stretch digits III and IV (Fig. 1). The aim of this study was to investigate the sensitivity, specificity, and efficacy of CTS-RM. MATERIALS AND METHODSWe examined 200 hands of 120 consecutive patients (101 women) referred to the EMG laboratory for hand paresthesias in the median nerve cutaneous distribution and pain exacerbation during the night. Mean age was 53.8 years (range 28-76 years). Duration of symptoms was 13.1 months (range 2 weeks to 7 years). At the time of clinical examination, 71 patients complained of positive symptoms such as paresthesias (tingling, "pins and needles," or a swollen sensation of the hands) or pain in a total of 112 hands.In these 112 hands we performed two maneuvers: (1) the basic relief maneuver combined, when symptoms were unaffected, with stretch of digits III and IV (Fig. 1); and (2) Phalen's test (extreme flexion of the wrist for 30 s). Patients were asked to indicate whether the maneuvers: (1) worsened; (2) did not change; (3) improved; or (4) abolished their symptoms. The patients were blinded to the possible effects of the maneuvers and the order of the maneuvers was random.At least 5 min after the maneuvers patients were studied electrophysiologically by determination of median sensory conduction velocity (SCV) from wrist to digit 2 (normal: Ն47 m/s) and median distal motor latency (DML) (normal: Յ4.2 ms). When these studies were normal, a median-to-ulnar comparison on stimulating the ring finger (normal median-ulnar latency difference: Յ0.5 ms) or a seg-

The Effectiveness of Carpal Bone Mobilization Accompanied by Night Splinting in Idiopathic Carpal Tunnel Syndrome

“…In the same systematic review, two studies evaluated the efficacy and significant benefit of manual therapy on patients with CTS (13,19). In Tal Akabi et al (13), trial effects of two manual therapy techniques, CBM and median nerve mobilization, were investigated in patients with CTS.…”

An innovative hand brace for carpal tunnel syndrome: A randomized controlled trial

“…Wrist splinting has been reported to improve CTS in 38–76% of patients, but such splinting was often associated with other treatments, and the studies were not controlled and were mostly retrospective 4, 11, 13, 14. We developed the Manu hand brace on the basis of a relief maneuver that rapidly relieves positive symptoms in CTS 16. It is conceptually very different from the currently available types of splint that work by immobilizing the wrist.…”

“…Recently, we noticed that gently squeezing the distal heads of the metacarpal bones (excluding the first) and stretching the third and fourth fingers relieved, in few seconds, the paresthesias and pain of CTS 16. This maneuver provided the rationale to design and develop an innovative hand brace for conservative treatment of CTS.…”

Differential diagnosis of atypical focal peripheral neuropathy: Case report

“…Passive accessory mobilization may increase the mobility of the wrist bones during movement, subsequently reducing impingement on the surrounding tissues. Several studies have investigated the benefit of manual therapy, including the treatment approaches of manipulation and mobilization (Akalin et al, 2002;Ferezy and Norlin, 1989;Manente et al, 1999;Valente, 1991;Valente and Gibson, 1994), although none has demonstrated methodological strength. Two studies that used joint mobilization suggest moderate benefits in range of motion and a reduction of pain versus those who received no treatment (Akalin et al, 2002;Manente et al, 1999).…”

“…Several studies have investigated the benefit of manual therapy, including the treatment approaches of manipulation and mobilization (Akalin et al, 2002;Ferezy and Norlin, 1989;Manente et al, 1999;Valente, 1991;Valente and Gibson, 1994), although none has demonstrated methodological strength. Two studies that used joint mobilization suggest moderate benefits in range of motion and a reduction of pain versus those who received no treatment (Akalin et al, 2002;Manente et al, 1999). Some evidence infers that manipulation and myofascial stretching may lengthen the flexor retinaculum, but these studies were performed on cadaveric tissue and extrapolation may be inappropriate (Sucher, 1994;Sucher and Hinrichs, 1998).…”