How do I know if I
have carpal tunnel syndrome?
Is surgery my only option to relieve my Carpal Tunnel
Syndrom (CTS) pain?
How does the CGO differ from a splint?
Why is the CGO more expensive than a splint?
What research has been done to prove the CGO’s
effectiveness?
How long has the CGO been on the market?
Do I need a prescription to get a CGO?
Is the CGO effective for post-surgery patients?
Is the CGO an effective preventative measure?
How do I know the CGO is working?
How soon can I see benefits from the CGO?
How does the CGO help while wearing at night?
Should I do any exercise along with wearing the
CGO?
How long do I need to wear the CGO?
Can I wear the CGO with work gloves?
How long can I expect the CGO to last?
Do I have to change my activities to get relief?
After wearing the CGO, how long before my Carpal
Tunnel Syndrome (CTS) symptoms come back?
Would the CGO benefit any issues other than the
median nerve?
Has any of the research that went into the development
of the CGO been published?
Will my insurance company reimburse me for the
CGO?
Can I give my CGO to someone else after I am done
with it?
What is the warranty?
Where can I get a CGO?
Is there anything I need to know when using the
CGO?
Like many other conditions, carpal
tunnel syndrome is frequently misdiagnosed. However, carpal tunnel
syndrome is very common, particularly in high-risk areas such
as repetitive work, assembly line, data processing, and writing.
Ergonomics has been cited as important in prevention and management
of carpal tunnel syndrome, but continues to contribute, to a large
degree, to the cost to employers and national health costs. The
symptoms are characterized by tingling and numbness in the fingers,
oftentimes, with accompanying wrist pain. Doctors and therapists
use manual tests to isolate carpal tunnel syndrome from a host
of other possible conditions and can reliably identify the presence
of median nerve inflammation that runs through the wrist that
causes the tingling and numbness in the fingers. Unfortunately,
other pinched nerves in the upper extremities and neck may contribute
to the same kinds of symptoms in the hand.
Only a health
professional that is well-trained and experienced in the area
of carpal tunnel syndrome and cumulative conditions, can tell
you if the symptoms are arising solely from the wrist or if there
are other contributing factors to the tingling and numbness in
the hand. By definition, researchers agree that compression of
the nerve occurs in the confinement of the tunnel that is formed
by the bones of the wrist and a band that is in the palm of the
hand. The band called the flexor retinaculum is cut to relieve
the pressure from the nerve when surgery is deemed necessary.
When the flexor retinaculum is cut there is a temporary volume
increase in the tunnel of the wrist where the median nerve travels
on the way to the fingers and thumb. The volume increase produces
a feeling of relief and fewer symptoms are usually the result.
It is not uncommon, however, that once the flexor retinaculum
heals, that symptoms begin to reoccur. The Bureau of Labor and
Statistics report that 60% of patients who received carpal tunnel
resection have return of some symptoms within 5 years.
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Answer: CTS pain is an indicator
that something is wrong in the mechanics of the wrist. This does
not always refer to carpal tunnel syndrome and may be tendonitis
or another number of inflammatory problems that are common among
people who indulge in repetitive activities at work and play.
Other symptoms related to wrist pain may include sensations traveling
up and down the arm and hand from the area of the wrist. This
is commonly understood by health professionals and is termed “referred
symptoms.” Referred symptoms make it difficult even for
health professionals without experience and training to know precisely
where the problem may arise. Once it is verified that pain in
the wrist is the result of carpal tunnel syndrome, the options
traditionally include surgery, steroid injections, casting, and
bracing (otherwise known as splinting which usually relies on
a metal piece in the palmar part of the hand and forearm). Bracing
is intended to greatly limit the use of the hand, because it has
been thought for many years that using the hand and arm too much
causes carpal tunnel syndrome, and that by not using the hand
and arm, the symptoms will go away. Unfortunately, the symptoms
do not go away in a profession where people must use their hands
repetitively and the braces generally interfere with all activities
of daily living in people that rely on their hands for a living.
This usually results in substitution, compensatory behaviors and
may worsen the condition because the metal inserts in the palm
of the hand are believed, by some researchers, to increase the
pressure around the nerve in the wrist and, typically, cause more
pain and symptomology in the long run.
Newer methods that have been found in industry to be highly effective
comprise the use of a co-dynamic orthotic. By definition, a co-dynamic
orthotic is a device that does not limit the hand function or
range of motion in any plane of the arm, wrist, and hand. However,
the co-dynamic orthotic provides one specific interference that
is unknown to most people and, by doing so, the symptoms of pain,
tingling, and numbness are readily improved while using the hand
in the manner that may have been thought to cause the problem.
Other means of avoiding symptoms of carpal tunnel syndrome is
to change jobs, refrain from using the hand in the manner in which
one has used their hand prior to the symptoms, take nutritional
supplements, and pursue other alternative therapy techniques.
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The Carpal Glove Orthosis (CGO) is
a co-dynamic orthotic that does not limit the hand motion or function
in any way. It simply interferes with one behavior or aspect of
wrist function that is the precursor to carpal tunnel syndrome
and compression of the nerves in the wrist. Preliminary research
has shown that, when interfering with this movement of the wrist
called volar translation, approximately 60% of the people who
wear the orthotic experience increased grip strength and greater
than 99% experience marked resolution of symptoms with maximum
performance in all planes of motion and not limiting the hands
in any particular way. A splint, however, is designed to rest
the hand yet it is misused often in that the splint is applied
to the person who is intended to return to the workforce and somehow
negotiate around the hard plastic splint or metal insert to perform
their regular hand activities. Splints by their very nature have
become very common. Yet, as popular as they are in the workplace
and in the general population, they do not appear to curb the
problem or reduce the number of surgeries that are performed yearly.
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The Carpal Glove Orthosis (CGO) has
undergone scrutiny for 15 years in a clinical setting, designing
to a very fine degree the precise interference necessary to allow
one to use their hand normally, yet provide a therapeutic input
for resolution of symptoms. The CGO is a patented and proprietary
product that has cost several million dollars to produce. It uses
materials that are fairly unknown by most industries and the materials
are of highest quality. The 302 stainless steel patented spring
imbedded in the material is CNC machined. Every orthotic is carefully
quality-controlled to provide the therapeutic benefit that years
of research and development can offer. A splint, on the other
hand, is a commonly used machine made device that is solely concerned
with immobilization. The materials are not particularly unique
and do not require any particular research or development. Splints
are mass produced usually by off-shore companies and have been
used by nearly all persons who have elected to have surgery to
release the median nerve at the wrist.
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Tinker Air Force Base engaged in
a civilian-military exchange agreement to develop a device or
testing fixture to measure translation forces of the wrist in
1993. The device showed clearly, in 1995, that translation forces
were particularly higher in people with carpal tunnel syndrome
than were non-symptomatic. Continued research and development
using that testing fixture confirmed with each modification how
effective counter volar carpal translation would be. In 2001,
the testing fixture called DIDACTS (Diagnostic Instrument for
Detection and Analysis of Carpal Tunnel Syndrome) showed quite
clearly that volar translation of the wrists in people with carpal
tunnel syndrome was much improved when a CGO or a variation of
a CGO was used to interfere with this translation. The DIDACTS
testing system showed progress according and associated with the
patients report of symptom relief and the tests that we use in
the industry for detecting median nerve compression called EMG
(electro myography study) or nerve conduction study (electro diagnostic
studies) that are designed to identify the slowing of nerve impulses
in a defined area. The slower the impulse, the more likely a nerve
is compressed as in carpal tunnel syndrome in the median nerve
in the wrist. With less and less encumbrance of the co-dynamic
orthotics, it became possible to introduce these orthotics into
a workplace setting where health professionals were not required
to oversee the condition on an ongoing basis.
One such study was performed by Delta Faucet, who reported that,
within 10 months, people who were on TTD (temporary total disability)
and were scheduled for surgery, returned to work and reported
resolution of symptoms within a 7 week period. Longer-term analysis
of the use of the carpal glove orthosis in a repetitive environment
demonstrated savings of $1.8 million in a period of only 10 months
of use in a company with 750 employees. Use of the orthosis now
in physician and therapist clinics are providing the same kind
of positive data. In every instance where the CGO is applied and
monitoring has been provided by health professionals, the symptom
resolution and the percentage of success are unprecedented compared
with current literature. Ongoing research is now being done by
multiple health professionals and some industry. Preparation is
being made for NIH studies concluding that the use of the CGO
on a hand with carpal tunnel syndrome will demonstrate improved
mechanics and reduction in symptoms that can be quantified and
verified by CT and MR 3-D reformation.
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The CGO I has been used clinically
since 2003 and the CGO II since 2004; the release of the orthotics
into the general population and various clinics around the country
since the middle part of 2005. The CGO I, however, is distributed
only to clinicians and is provided only by prescription. The CGO
II, however, is available to the general public and is easily
fitted and monitored by the patient with little or no professional
guidance. Generally speaking, if it reduces symptoms completely
other conditions are ruled out. If it does not work, it may indicate
that seeking health professional guidance is of greatest importance.
We recommend patient/consumer awareness and recommend that the
consumer learn all they can about the method and effectiveness
of the orthotic so that you may benefit in the maximum degree
and avoid problems that would ordinarily be problematic and costly.
It has been clinically demonstrated of over 500 hands that 90%
of the consumers using the orthotic need no further treatment.
With consumer advocacy, we believe that the majority of high-risk
environments will eventually utilize the product to minimize the
cost on our economy that this problem causes.
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The CGO I is stipulated only under
therapist or physician guidance and would require a prescription.
However, the CGO II can be provided off the shelf or in any other
means of distribution. If someone desires to seek insurance reimbursement
for the CGO II, a prescription would be required to submit to
your insurance company.
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Clinically, we have observed that
symptomology after carpal tunnel surgery is diminished or eliminated
regardless of the duration of symptoms or the length of time between
surgery and CGO fitting. Other clinicians and consumers have reported
the same kind of outcome. The explanation is fairly simple; when
surgery is performed, the flexor retinaculum is cut, temporarily
relieving the pressure around the median nerve in the wrist. When
the scar forms and heals, the flexor retinaculum oftentimes re-confines
the carpus and the initial problem of volar translation has not
been addressed. Once the volar translation is addressed by interfering
with it, the mechanics of the hand improve and the symptoms improve
as well.
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The companies who have used the CGO
I and II have found that after resolving symptoms during full
duty activities, the orthotics have been supplied to individuals
who no longer and thereafter complain of symptoms. The interpretation
when evaluating asymptomatic employees who were sucessfully treated
with the CGO II provides a valuable look at the cause of the problem.
The root cause being addressed would naturally lead one to the
conclusion that the CGO II is preventative. It has been documented
for several years, clinically, that 60% of the patients that are
EMG positive for carpal tunnel syndrome significantly increase
grip strength immediately upon fitting. It is thought that the
increase in strength is a sign of wrist stability which is believed
to be a strong countermeasure to the eventual compression of the
nerve in repetitive hand activities.
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If the CGO is fitted correctly, there
will be an immediate feeling and difference in the way the hand
performs. Clinicians often shake hands with a strong grip three
times. The third time the clinician points out to the consumer
that the grip is stronger and, when performing standardized testing,
the same is found to be true. Even when Jamar testing does not
demonstrate increased strength, the patient will report an improved
feeling of strength in their hand. Standardized Jamar testing
at a period of 2-3 weeks following application of the orthotic
will always indicate increased grip performance in conjunction
with decreased symptoms of tingling, numbness and pain.
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Often patients report, in the clinical
setting, that benefits are observed immediately. It is unknown
what percentage of patients rely on 24-48 hours before benefits
are noticeable. However, the majority would be the former.
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Little recognition has been given
to the effect of loss of sensation, nerve inflammation and diminished
position sense that relies on feedback information from the muscles
and joints to the spinal cord and the brain. The wrist of a carpal
tunnel patient often flexes at night. The explanation of that
can only be explained by one of the brain’s functions of
keeping tabs on every body part. If the information is diminished
from one part of the body, the brain will continue (like a computer
or server in network) to ping until it is identified by that part
of the body; just as a computer would provide an IP address. When
the brain does not get the information from the body part, let’s
say in this case the hand, the hand will begin to, in an automated
way, bend until pain fibers begin to provide the information that
the brain is looking for. When the wrist flexes two things occur
that are both negative. One is that no proprioception (position
sense) stimulation will acknowledge to the brain that the wrist
is present and accounted for and in a certain position. The position
that the wrist assumes that of flexion, allowing that communication
between the muscle, joint, and brain, increases the amount of
pressure on the nerve and, of course, increases the degree of
discomfort by the individual when they awake. The second problem
is that by increased pressure on the nerve, there is a greater
loss of communication by diminishing position sense fiber function.
The loss of communication between the muscle, joint, and brain
is called proprioceptive dysfunction or loss of position sense.
When the CGO II or the CGO I is applied, rarely does the wrist
go into a flexed position because the input from the patented
eccentric spring restores the feedback and ability to locate a
body part and the automated wrist flexion will no longer be necessary.
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Without the advice of a health professional
or thorough intense internet training session, it is best to avoid
a couple of things rather than provide any particular exercise.
- There is no literature that will support
the use of grip strengthening to reduce the symptoms of carpal
tunnel syndrome. The use of Theraputty, grippers and balls will
not assist someone in symptom resolution of carpal tunnel syndrome,
inflammation of the median nerve, or increased strength. If
a study should surface with evidence that grip strengthening
does assist someone in symptom resolution, I would like to be
advised of it.
- Stretching the wrist in the direction
of flexion cannot benefit the wrist whereby in that position,
the median nerve undergoes significant increased pressure and
thus increased symptomology almost necessitating the surgical
or invasive procedure for carpal tunnel release.
There are many exercises that would
be beneficial, however, only a few health professionals around
the country would be aware of the exercises that would be most
beneficial and how to avoid complications on the part of the consumer
attempting to perform these exercises on their own. There will
be an increasing amount of information on the internet and in
doctor and therapist offices in the very near future. At this
time, however, it is best to simply avoid doing what we know will
be counter-productive in conjunction with use of a co-dynamic
orthotic. Quite simply, therefore, avoid grip strengthening and
stretching of the wrist in the direction of flexion. This does
not mean that when you work or play that you should avoid the
use of your hand in any way. As you wear the Carpal Glove Orthosis,
the input will be positive according to reasonable standards of
hand use and normal activities. Do not strain or engage in physical
compromising or abusing hand activities. Use good judgment with
regard to the use of your hand. Use your hand as you would normally
in your work and play activities. By using “normal”
as a rule, the positive input from the co-dynamic orthotic will
be to the greatest degree effective.
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The CGO has been used for acute care
and for chronic conditions. Industry has found the use of the
CGO to be valuable as prevention. The determination of how long
to use the CGO is really up to the person that wears the CGO.
If you have symptoms of carpal tunnel syndrome, the CGO should
be worn, except for obvious reasons of safety, 24 hours a day
for 4-6 weeks. After that time, it would be up to the consumer
to determine if the CGO is good for prevention purposes when you
perform high-risk activities or if there may be some other clinical
reason that your physician or therapist might deem helpful.
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There is generally no reason why
the CGO would be hampered by the use of work glove or any other
apparel. There have been instances where wearing certain gloves
of a certain material might cause quicker wear of the material
of which the CGO is made. The CGO material is made from incredibly
durable material. However, because it is highly dynamic, moves
with the hand and arm throughout all the ROM and capacity of hand
function, it comes up against the greatest test of any materials
used in the past. The material itself contains a resistance to
stress in molecular breakdown of the material. Because of that
it can be highly abrasive and/or abrasive itself in the active
flexion and extension with apparel over the material that might
act as if an eraser to writing on paper.
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This varies greatly with the person’s
activity level, the environment with which they work and play,
even the chemicals that a person comes in contact with can hasten
wear and tear of materials. The CGO II has a one month guarantee
against defective materials and workmanship. In some cases in
industry, some workers have been provided “change-out”
of the CGOs once every 6-8 weeks. It is uncommon to see the orthotics
wear out or become irreparable sooner than that period of time.
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What we have seen clinically and
from what we have been told by thousands of consumers is that
the alteration of activities are generally not warranted. There
are certain activities that may not be prudent wherein wearing
a glove might cause risk to someone’s life as in using a
drill press or where one might be in a very wet environment that
could cause a build-up of moisture and/or bacteria. Chemicals
around the orthotic could also have an increasing sensitivity
to the skin where the orthotic comes in contact. In short, wherever
you would not use a wrist splint or other apparel, you may want
to avoid using the CGO. Otherwise, your activities should be helpful
to the hand with the orthotic in place as it will assist the hand
and arm in the activities mechanically and from a neuromuscular
point of view.
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There are patients treated by this
approach and various renditions of the CGO that are now 7 and
8 years post-treatment who have not worn the orthotic since and
have had no return of symptoms. Still, we know that the return
of symptoms will be readily correlated with the amount of volar
translation (that is the drop of the wrist), and the amount of
force with which the wrist drops during your hand activities will
determine if the CGO should be worn beyond a 4-6 week period or
whether a health professional should intervene and evaluate for
a stronger CGO called the CGO I that is available only by health
professionals.
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There is a great deal of evidence
mounting that the CGO is very beneficial in multiple ways. As
mentioned in this and other literature, when applying the CGO
the grip strength in 60% of the hands is immediately increased.
Because there is less translation of the wrist, there may be mechanical
benefits to the extrinsic musculature of the hand. That means
that the muscles that arise from the elbow that give the hand
the ability to extend and make a fist require less effort to perform
their tasks if the wrist is in a mechanically good position. If
the mechanics are impaired in the wrist, the amount of stress
where the muscles originate in the elbow could be substantially
higher. This same kind of condition could play out in other musculature
and ligamentous areas of the arm, wrist and hand. There have been
conjectures that wearing the CGO will assist in nerve and tendon
gliding and that the nerve and tendon gliding may have an input
in the normal nerve and tendon gliding in the more proximal areas
of the arm, hand and shoulder. There could also be some argument
that because the hand and arm are mechanically improved, there
are less compensatory behaviors and the upper extremities undergo
improved mechanics and sense of well-being that normalizes blood
flow and improved kinematics of the upper extremities as a whole.
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Two articles in abstract form have
been published in the Journal of Reconstructive Microsurgery 1.
Volume XVIII, Number 7, October 2002, p 645 entitled “Pisiform
Arthrokinematics and Carpal Tunnel Syndrome”. 2. Volume
XX, Number 4, May 2004, p 350 entitled “Unique Carpal Kinematics
in Confirmed Carpal Tunnel Syndrome Suggests Promising Treatment
Options”. 3. American Society for Peripheral Nerve 12th
Annual Scientific Meeting, Scientific Poster and Podium Presentation,
“The Theory of Environmental Deformity,” program book,
p 68.
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Insurance company reimbursement varies
from state to state. The state of Oklahoma, where the CGO was
pioneered, enjoys excellent insurance reimbursement. Almost all
billed CGOs have been paid in full under code A-4570, $175.00.
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Answer: It is not good practice to
share any kind of orthotic after wearing it for any length of
time. The most convincing reason to not share a CGO with another
is that the CGO will conform to the person’s hand in a very
unique way. It was designed to specifically address the issues
with each individual regardless of their various differences in
size and morphology. After wearing it for a short period of time,
the CGO will fit one person better than anyone. Other reasons
include sanitation and differences in use of perfumes and lotions
and so forth that may build up in material and become quite sensitizing
to another individual.
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30 days.
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The CGO II is available directly
from Kronos Teknology, or you may ask your health professional
to contact us. The CGO I can only be obtained from a health professional.
If your hand therapist or physician does not know about the CGO,
it would be helpful to inform them and give them our website information:
www.kronotek.com. More information will continue to be made available
in the near future as people become aware of the use of this new
technology. It is conceivable that insurance companies, case managers,
employers, organizations and health professionals will know about
the implication of using this orthotic and will promote the use
of the orthotic to address hand and wrist symptoms and to eliminate
symptomology in the workplace as it pertains to repetitive activities.
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Yes. When you apply the Carpal Glove
Orthosis II there should be a feeling of relief quite soon after
fitting. If not, that feeling of relief will be forthcoming, and
if it is not forthcoming, then one should contact a health professional
to assure that it is fitted correctly. If fitted and working correctly,
there may be odd sensations of which you become aware. In the
first few days there could be sensation of aching, feeling of
movement within the wrist when you’re using your hands.
There could be clicking sounds from time to time. This has been
documented hundreds of times in our and other clinics. This is
a temporary problem. The most satisfactory explanation of it is
what we refer to as “moving furniture.” If you move
the furniture, you know that you’ve got some places to sweep
and tidy up. When this orthotic is applied, the furniture tends
to move around in the manner that you would want it to be. Your
wrist contains several bones between the hand and the forearm.
It is a very busy place and the wrist has to negotiate a lot of
forces between the muscles that originate from the elbow and give
the hand its ability to open and close. There is no stabilizing
musculature of the carpal bones. So, the carpal bones are going
to move around in the direction where there is more force to move
it; in the direction of the stronger musculature that is in a
palmar direction. When you apply the CGO, there is neuromuscular
input and position sense input (also referred to as proprioception)
and this helps balance the muscular forces across the wrist that
help stabilize the wrist in the position that you desire; a position
of stability and, therefore, providing improved grip strength,
dexterity and coordination. It has become obvious to us that if
the wrist is fairly rigid and translated in a volar or palmar
direction, that it takes a good deal more time to have the benefit
that people with a flexible wrist have. It may also warrant professional
attention. The CGO I, that provides approximately three times
more interference, could be applied and correct the problem in
a way that is obvious, quick, and permanent. We estimate approximately
10% of the people with significantly provocative carpal tunnel
syndrome have more rigidity in their wrist and require this added
interference. Remember, however, the interference we are referring
to does not mean interference in range of motion or strength of
the hand. All planes of range of motion should be within normal
limits or within the limits that you previously possessed. The
orthotics must be in the position that we recommend and that is
in the palm of the hand; not beyond the palm of the hand towards
the crease of the fingers. Because if it is then it will limit
activities and it will be less effective in terms of co-dynamic
input. Significant pain or obvious pain that does not quickly
diminish is contraindicated and should immediately be brought
to the attention of your physician. The incidence of that is very
rare and usually if a wrist is traumatically unstable, the orthotic
will benefit. When the orthotic is removed after wearing for any
period of time, and the symptoms are significantly painful again,
then the likelihood of traumatic instability that requires a professional
evaluation is very great. The use of the Carpal Glove Orthosis
I and II have been used for traumatic wrist instability with very
good results, but should be used under the guidance of a physician
for that reason.
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Frequently Asked Questions (FAQ)