I have treated several patients who were referred
for "carpal tunnel syndrome" and unresponsive to
direct and traditional treatments. In all of these cases,
we found co-contraction of individual muscle groups
on certain fingers, as shown by elevated surface
(scan) EMG readings in the affected forearm.
One early patient was particularly interesting
because he had a large American flag tattooed
on his forearm. EMG readings in the "stars"
field of the flag were 25 microvolts, compared
with a normal 2.0 in every other location on the
same forearm. Since only one small muscle
was affected, his forearm in general had been
described as quite normal to palpation.
Treatment consisted of EMG biofeedback of
the affected area of the forearm, as well as
conventional PT treatments to the entire forearm,
instead of just the wrist.
Similar highly specific EMG elevations in the
forearm have been found in other "carpal tunnel
syndrome" patients, including a church organist
and others whose work required much finger
activity but permitted few "breaks" when soreness
A person highly experienced in manual techniques
could probably detect subtle differences in the
flexibility of certain fingers. But EMG is easier
and more objective.
When nothing works at the wrist site, consider
moving up the tendons to the muscles themselves.
John D. Perry, PhD, MDiv, BCIA, FAACS
(Psychologist specializing in biofeedback)
1192 Lakeville Circle
Petaluma, CA 94954
Mailto:[log in to unmask]
> A conultant has referred a male patient to me with a
> diagnosis of (R)
> carpal Tunnel syndrome. 3 month history. (R) hand dominant.
> He has occasional pain in his index finger and lateral
> border of forearm
> precipitating, factor unknown
> Cutaneous hypersensitivity of thenar eminence.
> Pain on palpation of snuff box.
> Pain ++ on palpation at a point where the superficial radial nerve
> passes over the radial styloid.
> Normal sensation in the rest of the palm, dorsum, fingers and tips.
> Full ROM of all fingers and wrist, slight pain on movement
> and resisted
> thumb opposition is painful.
> Skin texture is normal L=R.
> Skin has a mottled appearance
> There is no history of trauma.
> Compression/palpation of carpal tunnel has no effect
> Tens/icing of carpal tunnel has no effect.
> Ultra sound. 1:2. 1Mhz. .25 w/cm to carpal tunnel has no effect.
> Tens to carpal tunnel has no effect.
> Ultra sound 1:2. 3MHz. .25 w/cm to radial styloid has no effect.
> Ultra sound 1:2. 3MHz 1.0 w/cm to radial styloid exacerbates
> Tens to area of radial styloid gives relief when in use.
> He would appear to be well motivated, has a well paid job which he
> cannot afford to lose, but is in danger of doing so due to
> this problem.
> Looks like carpal in some respects but there is cause for
> doubt, could
> it be early RSD, if so does anybody have any effective treatment
> Your comments and advice would be much appreciated.
> Pete Purslow.