Abstract

Abstract

The osteopathic profession has long emphasized the importance of improving homeostasis and overall health through the use of osteopathic manipulative treatment (OMT). The respiratory-circulatory model seeks to achieve these goals by resolving somatic dysfunctions (SD) that may restrict venous and lymphatic return. One of the most significant somatic dysfunctions to address in this model is the thoracic inlet. Despite the emphasis on this somatic dysfunction, classic treatment approaches of the thoracic inlet remain some of the most challenging corrections.

In this article, an approach to somatic dysfunction of the thoracic inlet (SDTI) with a new application of Still technique principles is presented. This technique offers a safe, efficient, and effective treatment approach for patients who may present with substantial comorbidities. Considerations for difficult to correct SDTI are discussed. In addition, a more global approach is presented—with an awareness of the dynamic structural relationships and functionality of the region—to treat SDTI with enhanced success.

Abstract

We treated patients with carpal tunnel syndrome using OMT. Treatments were focused on the upper thoracic spine, lower cervical spine, and tenderpoints in the forearm muscles. OMT was not applied to the wrist in an attempt to stretch the transverse carpal ligament. MRI images were used to assess changes in fluid content in both the carpal tunnel and median nerve after OMT treatment. MRI measurements of median nerve area, carpal tunnel area and length of the transverse carpal ligament were also obtained. These measurements were correlated with changes in nerve conduction velocities (NCVs), pain ratings, wrist motion measurements, and somatic dysfunction information. The numeric data were compared and contrasted using Hest statistics. Significance probabilities of P < 0.05 were computed. Statistically significant changes were noted in pain ratings, wrist motions and nerve conduction (sensory amplitude). Five patients responded with improvement in symptoms and one did not. The responder group demonstrated a decrease in the amount of swelling of both the median nerve and carpal tunnel. The nonresponder demonstrated increased swelling in both the median nerve and carpal tunnel. Changes in the swelling of both the median nerve and carpal tunnel appear to more closely parallel changes in hand symptoms than nerve conduction results.¹ No statistically significant increases occurred in the length of the transverse carpal ligament or the carpal tunnel area. Minimal changes in both the length of the transverse carpal ligament and carpal tunnel area did occur despite no active attempts to stretch this region. All six patients had a predominance of acute changes in the upper thoracic spine and upper ribs. Most patients had tension in the flexor muscles of the forearm. Treatment of the upper thoracic spine, upper ribs, and forearms are all important in the management of carpal tunnel syndrome.