This week we had an interesting new case with a man named Frank.
Frank had an interesting career as a butcher and then later in life had gone to work for IBM. He’s 68 now and he’s had carpal tunnel problems for almost 8 years. His MD wants him to have his wrist cut open to "relieve the pressure" in his carpal tunnel. That might possibly work for Frank if his problem were actually located in his wrist. It isn’t and I say this because none of the standard carpal tunnel tests say it is. Phalen’s test and reverse Phalen’s test are both normal. Phalens test is performed holding the hands palms-together as in praying, forearms level, holding the wrists at a sharp 90 degree angle. Reverse Phalen’s test is the reverse of this position held sharply for 20- 30 seconds. If his problem actually originated in his wrist, where the surgeon wanted to operate, this test would elicit carpal tunnel symptoms - at least a little bit - but they don’t. Percussion of his carpal tunnel with the reflex hammer does not elicit carpal tunnel symptoms nor does forced extension of his index finger does not elicit carpal tunnel symptoms either, both of which you should see if the problem was in his wrist.
Although he’s never been in an accident, his neck x-rays tell a different story. I know the medical people will say he has arthritis in his neck but a better way to state it is he has advanced degeneration in his neck. Though the end result looks pretty much the same, arthritis results more from unequal weight-bearing within the joint and degeneration results from abnormal joint motion - usually loss of joint motion.
In chiropractic circles we refer to loss of joint motion as hypomobility. It is a subluxation if there is hypomobility with irritation to and change of nerve function.
There is advanced degeneration of Frank’s neck at precisely the area or level of his neck where the spinal nerves that form the median nerve (the one involved in carpal tunnel syndrome), exit the neck to go down the arm and to the hand.
Palpation of his neck reveals that several of the vertebrae of his neck are literally stuck - they don’t move individually (one to another) the way they should (hypo-mobility). When Frank and I both try to turn his neck - he cannot turn to the right more than 20 degrees. (Normal is about 85 - 90 degrees). When trying to turn his head to the left it turns to almost 45 degrees.
Hypomobilty causes irritation of the joint structures and this irritation causes cells to rupture and spill their contents outside the cells. This in turn sets off a chemical chain reaction that ends up irritating nerves which in turn send signals to the brain which we interpret as pain, tingling or numbness. Branches of those same nerves also carry signals to other areas within the brain which in turn initiates a cascade of altered functions, and unpleasant sensations and reactions.
Arthritis doesn’t do this and cutting his wrists will not stop the problem- because it’s not in his wrist at all. The origin of his carpal tunnel pain is entirely in the joints of his neck which are hypomobile. Surgery doesn’t seem like the right answer here at all. At the very best he will be unchanged but more likely it will leave him considerably worse. You can’t go in there cutting tissue and not create trouble, destroying healthy tissue, causing spacing occupying scarring, etc.
That said - I discussed with Frank my plan to "adjust" his neck to restore mobility in his neck. The x-ray reveals that C1 (top-most vertebra in the neck), is rotated posteriorly on the left and C5 is rotated posteriorly on the right. When looking at him you can easily see that. His neck is inclined to the right and his head is compensating by leaning to the left. His left shoulder is elevated and this all explains why he cannot turn his head to the right more than 20 degrees. The way the vertebrae are essentially "jammed" together or stuck so they lose their individual movement - they prevent normal movement of the entire neck.
Well, this case began on Monday this week. He came in for an adjustment Wednesday and Friday also. On Friday he reported being able to turn his head better. And he could - I measured it. Without help he turned his head to the right 45 degrees and 60 degrees to the left. Palpation revealed considerable improvement in joint mobility as well. That’s Not the best part of this story though. It’s a no-brainer - when you adjust a hypomobile joint ...it moves better. The best part was that the sensation in his left hand has improved already and it wasn’t hurting when he woke up this morning.
What is really astonishing is that he has suffered with this problem for 8 years and in one week with the proper care he is already starting to feel better.
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