Traditional Beliefs:
The commonly accepted belief is that carpal tunnel syndrome
is caused by a swelling of the tendons that line the carpal tunnel.
Typically it is believed that this swelling is the result of repetitive
movements. According to the National Institute for Occupational
Safety and Health (NIOSH), “job tasks involving highly repetitive
manual acts, or necessitating wrist bending or other stressful
wrist postures are connected with CTS… moreover, it is apparent
that this hazard is not confined to a single industry or job…”
Traditional Solutions:
Conventional treatment approaches are to immobilize the wrist
and hand, while at the same time expecting the patient to perform
the same tasks as before, retraining & reassignment, and surgery
referred to as Carpal Tunnel Release (CTR). These approaches demonstrate
a significant number of cases of symptom return, yet continue
to be implemented for lack of a better solution. NIOSH admits
that “Such medical interventions have met with mixed success,
especially when an affected person must return to the same working
conditions”. The BLS reported almost 70% of patients who
underwent CTR experienced return of symptoms within 5 years.
Recent Developments &
Discoveries:
Roger Williams is an Occupational Therapist that
specializes in hand rehabilitation. He has observed over the last
20 years that wrist translation (a wrist drop toward the palmer
side of the hand) is present in all CTS patients.
Anatomically, two muscle groups play an
important part in opening and closing the hand and fingers –
the flexors and the extensors. The flexors are located on the
palm side of the hand and forearm, and the extensor muscle groups
are located on the back side of the hand and forearm. The two
muscle groups exert forces that are balanced across the wrist
joint in a certain ratio. If that ratio is altered, a predictable
series of events occur that result in excessive joint shift that
Williams contributes to the diminished tunnel space causing nerve
compression leading to symptoms of pain, tingling, and numbness
in the hand and fingers.
In CTS patients, Williams observed in
the 1980s that the flexors over-control and minimize the positive
effect of the extensors, and the increasing disparity of the normal
ratio causes neuromuscular dysfunction that leads to wrist stabilization
problems. These increased forces can pull the wrist out of the
correct alignment which reduces the volume of the tunnel in the
hand where tendons and nerves must move. Because the wrist is
poorly aligned, the biomechanics of the hand and arm are compromised.
More force is needed to produce the same action in the hand, resulting
in the cyclic:
A new test was developed
by Roger Williams in the late 1980s that measures the position
resistance in a patient’s wrist. This method has been found
to reliably identify the muscle and joint condition that leads
to symptoms of carpal tunnel syndrome. The test is used to accurately
diagnose and predict CTS, track patient’s progress, and
quantify level of severity and prognosis. The test began as a
manual test; practically 100% accurate in CTS diagnosis, called
Dorsal Glide (DG) and was presented to the American Society for
Peripheral Nerve in 2002, 2003, and 2004.
An independent study has
verified the effectiveness of using Dorsal Glide to verify CTS
(Goloborod’ko, Sergey A., Provocative Test for Carpal Tunnel
Syndrome, Journal of Hand Therapy, Vol. 17, Num. 3, pp 344-348,
July/September 2004).
The DG test was mechanized
and constructed in cooperation with the United States Air Force
in a civilian military agreement in the mid 1990s and automated
and programmable in it’s current form, referred to as DIDACTS,
Diagnostic Instrument for Detection and Analysis of Carpal Tunnel
Syndrome.
Williams’ observations
led to the creation of the Carpal Glove Orthosis™ (CGO™).
Unlike a splint that restricts movement that is intended to offer
temporary relief by resting the hand and arm, the CGO™ allows
full movement while reducing the poor alignment and facilitating
re-education of the target muscle groups. The typical end result
of using the CGO™ in the activities that were previously
provocative, are now what allows muscles to regain their force
couple balance and the wrist remains stable and in proper position
and that coincides with symptom resolution in the majority of
CTS cases.
Non-Traditional
but Outstanding Outcomes:
Williams has been using the new orthotic and treatment
protocols with local industry and in his clinic, Midwest City
Therapy Inc. Patients fully recover without changing life style
or behavior because the CGO™ encourages maximum potential
hand function and capacity while stabilizing the wrist throughout
all positions of the forearm, wrist and hand. The original device
called the Carpal Glide™ demonstrated hundreds of successes
under Williams’ close supervision but now the simplified
version requires little or no supervision, and is changing traditional
thought concerning carpal tunnel syndrome. It has evolved into
a simple “dynamic wrist glove” called the Carpal Glove
Orthosis™ II (CGO™ II). It is now offered with an
embedded patented spring that performs with a high degree of precision
within the fabric. The new CGO™ II encourages normal wrist
movement, is simple to fit, and is literally unnoticed by the
user. While the hand is performing any job, the CGO™ II
is protecting and promoting improved joint mechanics. As Williams
has often said, “one cannot make a perfect environment with
which to work, but we can become more resilient and athletic in
our working environment”…. “By knowing how the
biomechanics are affected by repetitive work, embedded technology
holds the key to creating a world free of carpal tunnel syndrome.”
Carpal Tunnel Syndrome Explained