When attempting to gain entry into the industrial health care delivery system for the treatment, rehabilitation and prevention of repetitive stress injuries (RSI’s), the chiropractor must first know how to diagnose differentially, follow a standard protocol, be prepared to disclose how many cases he/she has successfully treated and provide references, as well as identify additional specialized training and expertise in the field of RSI’s and cumulative trauma disorders (CTD’s).
Epidemiologically, reports indicate that RSI’s and CTD’s constitute the highest incidence of occupational injuries. The serious magnitude of CTD’s in the workplace has, according to many, reached “epidemic proportions.”
The United States Department of Labor, Bureau of Labor Statistics (BLS), released a survey of occupational illnesses and injuries indicating that, “Over the past several years, disorders associated with repeated trauma have increased significantly, both in number and as a percentage of total occupational illnesses reported.”
According to the Occupational Safety and Health Administration (OSHA), the survey reveals increases in rates of occupa-tional injuries and illnesses, as a direct result of an em-phasis on more accurate record keeping and focus on job safety and health. The results also demonstrated parallel increases in injuries reported to the industries that OSHA targeted for its vigorous enforcement.
There exist several functional facts and fictional fantasies regarding the diagnosis, treatment, rehabilitation and case management for RSI/CTD patients. There will always be philosophical and clinical diversity among chiropractic and allopathic practitioners. Moreover, treatment options vary significantly from nutrition, manipulation of the carpals, physical therapy, flexible splinting and ergonomic recommendations while on the job, to off work cortisone injection, rigid splinting, NSAID’s, surgery and re-operations.
With the advent of specialized X-Rays of the carpal tunnel (X-POSER) that clearly demonstrate the osseous occlusion and biomechanical collapse of the carpal arch, optional MRI confirms the soft tissue components by visualization, flattening and increased signal intensity of the median nerve and a characteristic palmar bowing of the flexor retinaculum. A detailed history should include occupational, domestic, habitual and athletic relative questioning, orthopedic testing, nerve conduction velocity (NCV) to differentially diagnose CTS from the four other less common median nerve entrapments from the elbow to the hand (Pronator Teres Syndrome, Anterior Interosseous Syndrome, Palmar Fascitis, Collateral Digital Nerve Syndrome).
While other conditions may contribute to or mimic CTS, remember that the definition of CTS is median nerve entrapment at the wrist, etiologically the result of a decrease in the size of the carpal tunnel and/or an increase in the contents therein.
Treating Carpal Tunnel Syndrome
As previously noted, chiropractic treatment should include physical therapy, nutrition (bromelain, papain, trypsin, chymotrypsin, citrus bioflavonoids and vitamin B6) and Low Level Laser Therapy that dramatically reduces inflammation, improves circulation, accelerates recovery, reduces scar tissue and promotes healing by stimulating the immune system.
A quandary over which laser technology to purchase exists, ranging from laser pointer wavelength frequencies of 630-650 nm to the most effective laser with 830-850 nm wavelength. For more accurate information, visit the FDA website, and review the FDA clearance and statements on the various laser products and companies. Do your homework!!!
Rehabilitation varies from puddy to weights. However, I, personally, utilize an in-office state-of-the-art system that trains the patient during rehab; and, after 4 weeks (3x/wk), I equip the patient with a home unit for continued compliance. Patients are sent home with a written colored pictorial guide, treatment plan and progress forms on NCR paper and are required to provide the doctor with copies of the prescribed and completed exercises.
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