6.8: Carpal Tunnel Syndrome

Carpal Tunnel
Syndrome
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6.8: Carpal Tunnel Syndrome
Carpal tunnel syndrome is a series of clinical symptoms caused by
various of injuries which lead to increased pressure on the median nerve
from the forearm to the wrist and flexor digitorum through the tunnel.
Clinically this is mainly characterized by numbness of “three and a half
fingers”, paresthesia of sensation, carpal atony.
“Carpal Tunnel Syndrome”
“Frequent occurrence among middleaged or old people or even office
workers, especially among females”
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6.8: Carpal Tunnel Syndrome
【Anatomy Structure】
 The median nerve
-controls sensations to the palm side of the thumb and fingers (although
not the little finger), as well as impulses to some small muscles in the
hand that allow the fingers and thumb to move.
 The carpal tunnel
-a narrow, rigid passageway of ligament and bones at the base of the
hand - houses the median nerve and tendons.
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6.8.1: Carpal Tunnel Syndrome
-Pathogenesis
Wrist strain, direct trauma, wrist bone fractures, dislocation, malunion,
hyperosteogeny, ligament hypertrophy, ganglion and adipoma
Compression at the median nerve
Numbness / Paresthesia
Carpal Tunnel Syndrome
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6.8.2: Carpal Tunnel Syndrome
-Clinical manifestations
The onset of this disease is slow. Is usually marked by an acute or chronic injury.
 Early stage:
1) are soreness and distention of the wrist.
 Later stage:
1) Symptoms of median nerve pressure with signs of paresthesia, numbness
and stabbing pain, electronic shock in the thumb, index, middle and ring
finger (three and a half fingers at the radial side), even radiate to elbows and
shoulders;
2) Symptoms worsened in 40 seconds when bending the wrist in 90 degree
angle;
3) Symptoms are severe at night and in the morning;
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6.8.2: Carpal Tunnel Syndrome
-Clinical manifestations
4) Aggravated when temperature of hand increases and hand become tired and
droop; alleviated after moving , swinging and lifting of hands.
5) Fingers on the affected side feel distending, stiff and cold.
 Advanced stage:
1) Thenar atrophy, numbness, reduced muscular tension, loss of impairment of
sensation in the fingers, dysfunction of palm flexion
2) X-ray shows no abnormal changes, ruling out bone lesion
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6.8.3: Carpal Tunnel Syndrome
-Diagnosis
【Essential for Diagnosis】
1. Carpal pain accompanied by pain and numbness of three and a half
finger at the radial side.
2. Anomalous skin sensation in the distribution area of median nerve.
3. Stabbing and electronic shocks numbness is felt when carpal tunnel
is knocked.
4. The test of flexing wrist is positive.
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6.8.4: Carpal Tunnel Syndrome
-Treatment
【Therapeutic principles】
1. Activating blood to eliminate swelling
活血消肿
2. Soothing tendons and unblocking
collaterals
舒筋通络
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6.8.4: Carpal Tunnel Syndrome
-Treatment
【Locations of Acupoints】
Wrist
•Daling
大陵 (PC7)
•Neiguan
内关 (PC6)
•Quze
曲泽(PC3)
•Yuji
鱼际(LU10)
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Daling (PC7)
Neiguan (PC6)
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Quze (PC3)
Yuji (LU10)
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Pericardium meridian PC
Quze (PC3)
Neiguan (PC6)
Daling (PC7)
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6.8.4: Carpal Tunnel Syndrome
-Treatment
【Basic Manipulations】
1. Pressing and kneading Daling, Neiguan, Quze, Yuji and carpal tunnel.
1 minute for each Acupoint till soreness and distention are felt.
2. Pressing and kneading carpal tunnel with the thumb, vertically
plucking towards the flexor digitorum, combined with shaking and
pulling manipulations alternatively for about 5 minutes.
3. Grasping, pressing, kneading from the forearm flexor muscle to the
wrist with the carpal as to relax the muscles of forearm for about 5
minutes.
4. The affected elbow is bent into 45 degree angle. The doctor fixes the
wrist of the affected limbs with one hand, and then pushes and kneads
from the wrist to antebrachium flexor with the other to push the
extravasation to the forearm muscles so as to relieve pressure inside
the tunnel.
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6.8.4: Carpal Tunnel Syndrome
-Treatment
5. The patient is in a sitting position with his dorsum of hand turned upwards.
The doctor holds the palm side of the patient’s hand with four fingers of
both hands, puts his thumbs on the back of the wrist, pressing the wrist
with the thumbs, pulling the wrist and wagging it at the same time. While
pressing with the thumb, the doctor extends the wrist back to the maximum
range, immediately bending the wrist and wagging repeatedly several times
for about 5 minutes.
6. Then rubbing the wrist joint to finish the treatment.
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6.8.4: Carpal Tunnel Syndrome
-Treatment
【Cautions】
1. After each treatment, fomentation may be applied to the local areas, twice a day.
2. Avoid over using the wrist during treatment period.
3. Keep the wrist warm. Wear wrist guard if necessary.
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Sprain of wrist joint
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6.9: Sprain of wrist joint
Sprain of wrist joint is caused when the wrist joint is impacted by direct
or indirect external force, or rotates beyond the endurance of the wrist
ligament and thus injures the ligament, tendon and articular capsule
around the wrist. Severe incidents can cause wrist fracture.
Pain and swelling around the wrist joint with limited functional motion.
“Sprain of Wrist joint”
“commonly seen among young people
who are active”
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6.9: Sprain of wrist joint
【Names in TCM】
 Injury of tendons that leads to stagnation of Qi and blood.
“筋脉受损，气血凝滞”
 Bone dislocation and tendon displacement
“骨错缝，筋出槽”
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6.9.1: Sprain of wrist joint
-Pathogenesis
Wrist joint (abundant Qi with less blood)
Three Yin/Yang meridians of hand
Acute or chronic trauma
Injury of tendons and joints
(looseness and spasm of tendons,
adherence or dislocation of joints)
Restricted activity and pain due to
stagnation of Qi and blood
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6.9.2: Sprain of wrist joint
-Clinical manifestation
1.
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•
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History of obvious injury:
Falling down with the palm hitting on the ground;
Wrist sprain while working or taking sports activities;
Carrying heavy objects or over strain in long period of time.
2. Mild condition:
• Wrist appear less agile, with no distinct pain. Pain only occurs in
large motion.
3. Severe condition:
• Pain occurs right after injury and with restricted movement, limitation
in turning to a certain direction;
• Swelling and subcutaneous ecchymosis in the wrist
• Appears bluish, then purple and yellow or khaki
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6.9.2: Sprain of wrist joint
-Clinical manifestation
4. Evident of pain, tenderness and activity limitation in the injured area:
a) Tenderness:
• At the radial aspect of dorsal radial-carpal ligament
-(injury of ligamentum carpi dorsal)
• At the palm side of the ligamentum carpi volare
-(injury of ligamentum carpi volar)
• At the radial aspect of the nasopharyngeanl fossa
-(injury of radial collateral ligament)
• At the small head of ulnar
-(injury of ulnar collateral ligament)
• At the space of radioulnar joint and radial collateral aspect of wrist joint
-(injury of triquetrum cartilages)
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6.9.2: Sprain of wrist joint
-Clinical manifestation
b) Restricted activities:
• Pain in flexing and stretching movement with the wrist and palm
-(Injury of ligament carpi dorsal)
• Pain in backwards stretching
-(Injury of ligament carpi volar)
• Pain in ulnar flexion movement
-(Injury of radial para-ligament)
• Pain in radial flexion
-(Injury of ulnar para-ligament)
• Pain in inward rotation
-(Injury of triquetrum cartilage)
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Dorsal side
(Ligament carpi dorsal)
Palm side
(Ligament carpi volar)
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Triquetrum cartilages
Radial collateral ligament
Ulnar collateral ligament
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6.9.2: Sprain of wrist joint
-Clinical manifestation
5. X-ray examination:
• No evident change for a simple sprain of wrist joint.
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Distinguished for evident in:
-fracture of the distal end of radius and ulna;
-fracture of scaphoid;
-fracture or dislocation of lunate bone, avulsion fracture of the dorsum of
triquetrum bone;
-aseptic necrosis of scaphoid and lunate bone
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Right palm side
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6.9.3: Sprain of wrist joint
-Diagnosis
【Essential for Diagnosis】
1. History of acute or chronic injury.
2. There is pain in the wrist joint and the pain is located in the injured place.
3. Arthrocele, indistinct signs in chronic injury, evident swelling, distension
and subcutaneous ecchymosis in acute injury.
4. Restricted movement and function of the wrist.
5. Ruling out fracture or dislocation with X-ray examination.
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6.9.4: Sprain of wrist joint
-Treatment
【Therapeutic principles】
1. Soothing tendons and activating blood
舒筋活血
2. Removing blood stasis and unblocking
collaterals
祛瘀通络
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6.9.4: Sprain of wrist joint
-Treatment
【Locations of Acupoints】
Acupoints are selected according to the injured area (dorsal side)
•Waiguan
外关 (TE15)
•Hegu
合谷 (LI4)
•Yangxi
阳溪 (LI5)
•Yanggu
阳谷 (SI5)
•Yangchi
阳池 (TE4)
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Waiguan (TE15)
Hegu (LI4)
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Yangxi (LI5)
Yanggu (SI5)
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Yangchi (TE4)
Yangchi
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Yanggu (SI5)
Yangchi (TE4)
Yangxi (LI5)
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6.9.4: Sprain of wrist joint
-Treatment
Acupoints are selected according to the injured area (Palm side)
•Taiyuan
太渊 (LU9)
•Shenmen
神门 (HT7)
•Daling
大陵 (PC7)
•Lieque
列缺 (LU7)
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Taiyuan (LU9)
太
渊
穴
Shenmen (HT7)
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Daling (PC7)
Lieque (LU7)
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Taiyuan (LU9)
Daling (PC7)
Shenmen (HT7)
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6.9.4: Sprain of wrist joint
-Treatment
【Basic Manipulations】
 Therapy can only be applied after ruling out fracture or dislocation
with X-ray.
 Therapy should be applied 24 to 48 hours after an acute injury, if
swelling and subcutaneous ecchyoma are distinct.
1. (a)Sprain on the palm side of the wrist: Daling, Shenmen and
other Acupoints of the heart meridian can be used; (b)Sprained on
the radial aspect of the wrist: Lieque, Taiyuan, and other
Acupoints of lung meridian can be used; (c)Sprained on the dorsal
side of the radial aspect of the wrist: Yangxi, Hegu and other
Acupoints on the large intestine meridain can be used.
Pressing and thumb kneading with proper strength until the patient feels
aching.
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6.9.4: Sprain of wrist joint
-Treatment
2. The patient take a sitting position. The doctor applies pressing,
kneading and plucking on the injured area. The manipulations
should be done mildly and gently for 5 minutes. From distal to
proximal injured area.
3. Passive movement: dorsiflexion, palmer flexion, bending and
circular movement to the left and right, extending and shaking the
wrist in order to relieve spasm and adhesion and improve the
function of the wrist. Perform 5 minutes for such manipulations.
4. Scrubbing the injured area of the wrist for 2 minutes till warmth
penetrates deep inside the muscles.
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6.9.4: Sprain of wrist joint
-Treatment
【Cautions】
1. For acute injury with subcutaneous hemorrhage, ice compress
should be used first to prevent bleeding.
2. For severe injury, X-ray should be used to rule out fracture and
dislocation.
3. Keeping warm and protecting the wrist with wrist guard during
treatment period.
4. Reduction manipulation should be applied for suspecting of
dislocation and avulsion fracture. Fixation should be continued only
after 6-8 weeks of union of fracture. Tuina therapy can be
considered to restore the function of the joint.
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