The AAO Journal, 2025/06, 35(2):20. doi: 10.53702/i2375-5717-35.2.13, type of study: ,cr,

Full text    (https://aaoj.kglmeridian.com/view/journals/aaoj/35/2/article-p13.xml)

Keywords:

carpal tunnel syndrome [40]
case report [736]
female [654]
median nerve [15]
OMT [3924]
osteopathic manipulative treatment [3945]
ultrasound [56]
women [607]

Abstract:

Introduction: Carpal Tunnel Syndrome (CTS) is a common compressive neuropathy, with symptoms ranging from mild tingling in the fingertips to severe paresthesia and discomfort in the hand. Osteopathic Manipulative Medicine (OMM) has been shown to manage this condition; however, treatment validation using musculoskeletal ultrasound remains unexplored. Case: A 24-year-old female presented with a one-week history of left neck and shoulder tightness radiating to the jaw and hand, accompanied by a one-month history of numbness, tingling, and weakness in the left arm. Physical exam findings included a superior right first rib, left atlanto-occipital (OA) compression, decreased left temporal bone motion, and left jaw deviation. Ultrasound of the left wrist revealed median nerve adhesion with fluid accumulation. Pre-treatment ultrasound measurements of the carpal tunnel and median nerve were obtained. She was treated with rib muscle energy, Sibson’s fascia release, OA Still technique, temporal bone balanced membranous tension, and jaw balanced ligamentous tension. Additionally, interosseous membrane release, carpal tunnel myofascial release, and petrissage was performed on her left arm. Results: Post-treatment repeat ultrasound showed a reduction in fluid, increased carpal tunnel cross-sectional area (CSA), decreased median nerve CSA and increased motion. Patient also reported decreased symptoms and reduced shoulder tightness. Discussion: This case presents a patient with shoulder tightness accompanied by paresthesia in her left arm. It also demonstrates the immediate impact of OMM on increasing the carpal tunnel area and contributes to existing literature by incorporating ultrasound during the visit, as opposed to relying on MRI and CT like pre-existing studies. Future work would include studying a larger, more diverse cohort of patients, including those at high-risk of developing CTS due to their occupations, pregnancy, or other health conditions.