Dynamic carpal tunnel syndrome: pathophysiology, features of osteopathic diagnosis and treatment

Abstract

The goal of the review is the systematization of the main factors influencing on the appearance of clinical signs of carpal syndrome of median nerve. In this lecture, an emphasis is placed on the problem of dynamic carpal tunnel syndrome, the symptoms of which are provoked by physical exertion and/or a certain position of the limb, due to compression and/or overstretching, as well as abnormality of longitudinal and transverse sliding of the median nerve. These symptoms subside with the termination of the action of the provoking factor and return when the movements are repeated. Neurological examinations and nerve conduction tests performed at resting state usually do not reveal changes. This lecture also discusses the features of clinical biomechanics and pathophysiology of the median nerve. For topical diagnosis of the level of nerve compression and in order to accurately understand whether there is an abnormality of the mobility of the nerve tissue, it is necessary to carry out manual testing of the muscles innervated by the median nerve, with the arm and neck of the patient being examined in a neutral position, and during provocative neurodynamic tests. According to clinical neurodynamics therapeutic measures should be directed to all interdependent components of the peripheral nervous system in the following sequence: osteopathic treatment of the nerve trunk interface (tissues surrounding the nerve trunk); osteopathic treatment of innervated tissue; osteopathic treatment of the connective tissue of the median nerve. During this sequence of treatment, we carry out manual correction of the functional blocks of the joints of the hand and the radiocarpal joint, inactivate trigger points in the muscles surrounding the median nerve (round pronator, flexors of the fingers of the hand, etc.), carry out fascial release directly to the nerve bed itself. Then we perform passive and active mobilization of the nerve trunk in the longitudinal and transverse directions. After the end of osteopathic treatment, it is necessary to prescribe special neurodynamics exercises to mobilize the median nerve.