Medical References: Repetitive Strain Injuries, Carpal Tunnel Syndrome

FLEXTEND STUDY LINKS
> FLEXTEND STUDIES HOME

> ALLIED HEALTH ASSOC.

> PACIFIC UNIVERSITY #1
> PACIFIC UNIVERSITY #2
> PACIFIC UNIVERSITY #3
> IN-FOCUS CORPORATION
> INDEPENDENT CLINIC
> TESTIMONIALS
> MEDICAL REFERENCES

 

Muscle Imbalance as a Factor in the Development of Carpal Tunnel Syndrome (CTS) and Repetitive Strain Injuries (RSI'S).
  • Musculoskeletal disorders of the upper extremities include carpal tunnel syndrome, tendonitis, epicondylitis. Both non-occupational and occupational factors contribute to the development and exacerbation of these disorders.

  • FLEXTEND helps address muscle imbalance disorders by strengthening the associated intrinsic and extrinsic extensors and abductors in order to establish equal pull/tension on both sides of the joint. Creating an environment where there is muscle balance can help decrease compression of the anterior wrist and forearm caused by the stronger, overused flexor muscles. Increasing extensor strength can promote stability of the affected joints by decreasing the tensile stresses imposed by the flexors onto the weaker extensor muscles, which stabilize the finger and wrist joints in the functional neutral position.
  • Fry has proposed that muscle overuse leads to direct painful sequelae and muscle changes. Biopsy of the first dorsal interosseus muscle has shown non-specific fiber ratio changes. Dennet X, Fry HJH. 1988. Overuse syndrome: a muscle biopsy study. Lancet 1: 905-8

  • The flexor muscles of the forearm have a large effect on carpal tunnel pressure by acting on and within the carpal tunnel (Keir et al., 1995).

  • "All of the extrinsic hand muscles become involved in a power grip, in proportion to the strength of the grip."........ "Strong agonist-antagonist interactions are needed between the flexors and extensors of the hand and fingers to produce forceful hand-grip. Powerful flexion of the distal phalanges requires strong activity also of the finger extensors." ". Janet G. Travell, M.D. and David G. Simons, M.D. Myofascial Pain and Dysfunction-The Trigger Point Manual. Volume1 Upper Extremities, Ch:35, pg. 501. Copyright 1983.

  • "Muscle balance must be restored with specific exercises. Otherwise, the already strong and overused muscles get stronger, and the weak and underused muscles remain weak. Individuals get good at using the overused muscles and must be trained specifically to recruit and strengthen the weak underused muscles." Philip E. Higgs, M.D. and Susan E. Mackinnon, M.D. Department of Surgery, Washington University School of Medicine, St. Louis, Missouri. Annu. Rev. Med. 1995. 46:1-16.

  • "Actions of the finger extensors are primarily extension of the fingers, and the hand, at the wrist. They (extensors) make as essential contribution to forceful finger flexion." Janet G. Travell, M.D. and David G. Simons, M.D. Myofascial Pain and Dysfunction-The Trigger Point Manual. Volume1 Upper Extremities, Ch:35, pg. 497. Copyright 1983.

  • "Activation of the hand extensors (muscles), is essential to the power grip." Janet G. Travell, M.D. and David G. Simons, M.D. Myofascial Pain and Dysfunction-The Trigger Point Manual. Volume1 Upper Extremities, Ch:34, pg. 485. Copyright 1983.

  • "The theory we propose explains pain, paresthesia, and muscular tenderness on the basis of multilevel nerve compression caused by postural abnormalities and muscle imbalance." Philip E. Higgs, M.D. and Susan E. Mackinnon, M.D. Department of Surgery, Washington University School of Medicine, St. Louis, Missouri. Annu. Rev. Med. 1995. 46:1-16.
  • "If certain muscle groups are underused, opposing muscle groups will be overused. Muscles in either a lengthened or shortened position will be at a mechanical disadvantage and weak. The overused group will hypertrophy, and the underused group will continue to be weak. This combination produces a self perpetuating condition that maintains the abnormal posture and muscle imbalance." Philip E. Higgs, M.D. and Susan E. Mackinnon, M.D. Department of Surgery, Washington University School of Medicine, St. Louis, Missouri. Annu. Rev. Med. 1995. 46:1-16.

  • There are several factors which have the potential to increase carpal tunnel pressure. Cadaveric research has demonstrated that the movement of the lumbricals can increase pressure by occupying space within the carpal tunnel (Cobb et al., 1994).

  • Static fingertip loading (gripping/flexing finger tips against an object) has also been shown to increase carpal tunnel pressure (Rempel et al., 1994).
  • Allied Health Associates FLEXTEND® Study Medical References
  • 1. Dannet X-Fry, a muscle biopsy study. "Overuse Syndrome" Lancet 1=905.8.
  • 2. Janet G. Travell, M.D. and David G. Simons, M.D., Myofacial Pain and Dysfunction, The Manual Vol. 1 Upper Extremities, Ch: 35, Pg. 501. Copyright 1983.
  • 3. Phillip E. Higgs, M.D., Susan E. Mackinnon, M.D. Department of Surgery, Washington State School of Medicine, St. Louis, Missouri. Annv. Rev. Med. 1995. 46: 1-16.
  • 4. Corrie Holloway, D.C.O., Q.M.E., Clinical Director Allied Health & Associates, Los Angeles, CA. 06/01/2000 to 10/01/2000.
  • 5. Mel Braxton, D.C. Sports Injury Rehabilitation Specialist Allied Health & Associates, Los Angeles, CA. 06/01/2000 to 10/01/2000.


    Pacific University FLEXTEND® Study Medical References
  • 1. Phalen GS. The Carpal-Tunnel Syndrome. The Journal of Bone and Joint Surgery. 1966 Mar; 48A(2):211-228.
  • 2. Szabo RM. Carpal Tunnel Syndrome as a Repetitive Motion Disorder. Clinical Orthopedics and Related Research. 1998 June; (351):78-89.
  • 3. Mackinnon SE, Novak CB. Repetitive strain in the workplace. Journal of Hand Surgery. 1997; 22A:2-18.
  • 4. Harter BT, McKiernan JE, Kirzinger SS, Archer FW, Peters CK, Harter KC. Carpal tunnel syndrome: Surgical and nonsurgical treatment. The Journal of Hand Surgery. 1993 Jul; 18A(4):734-739.
  • 5. Cullum DE, Molloy CJ. Occupation and the carpal tunnel syndrome. The Medical Journal of Australia. 1994 Nov 7; 161:552-554.
  • 6. Nancollas MP, Peimer CA, Wheeler DR, Sherwin FS. Long-term results of carpal tunnel release. The Journal of Hand Surgery. 1995 Aug; 20B(4):470-474.
  • 7. Slater RR Jr, Bynum DK. Diagnosis and Treatment of Carpal Tunnel Syndrome. Orthopedic Review 1993 Oct:1095-1105.
  • 8. Cailliet R. Hand Pain and Impairment. 3rd ed. FA Davis: Philadelphia, 1982.
  • 9. Linscheid RL. Kinematic considerations of the wrist. Clinical Orthopedics 1986;202:27-39.
  • 10. Norkin CC, Levangie PK. Joint Structure and Function. 2nd ed. F.A. Davis: Philadelphia, 1992.
  • 11. Garcia-Elias M et al. Stability of the Transverse Carpal Arch: An Experimental Study. The Journal of Hand Surgery. 1989; 14A:277-282.
  • 12. Moore KL. Clinically Oriented Anatomy. 3rd ed. Williams & Wilkins: Baltimore, 1992.
  • 13. Netter FH. Atlas of Human Anatomy. CIBA-GEIGY: Summit, Plate 448.
  • 14. Kulick RG. Carpal Tunnel Syndrome. Orthopedic Clinics of North America. 1996 Apr; 27(2): 345-354.
  • 15. MacConaill MS, Basmajian JV. Muscles and Movements: A Basis for Human Kinesiology. Williams & Wilkins: Baltimore, 1969.
  • 16. Youm, Y, McMurtry RY, Flatt AE, Gillespie TE. Kinematics of the Wrist. The Journal of Bone and Joint Surgery. 1978 Jun; 60A(4):423-431.
  • 17. Netscher D, Mosharrafa A, Lee M, Polsen C, Choi H, Steadman AK, et al. Transverse carpal ligament: its effects on flexor tendon excursion, morphological changes of the carpal canal, and on pinch grip strengths after open carpal tunnel release. Plast Reconstr Surg. 1997 Sep; 100(3):636-42.
  • 18. Mackinnon SE, Dellon AE. Surgery of the Peripheral Nerve. Thieme Medical Publishers: New York, 1988.
  • 19. Szabo RM. Acute carpal tunnel syndrome. Hand Clinic. 1998 Aug; 14(3):419-29, ix.
  • 20. Gelbermann RH, Hergenroeder PT, Hargens AR, Lundborg GN, Akeson WH. The carpal tunnel syndrome: a study of carpal canal pressures. Journal of Bone and Joint Surgery. 1981; 63A: (3) 380-383.
  • 21. Muffly-Elsey D, Flinn-Wagner S. Proposed screening tool for the detection of cumultive trauma disorders of the upper extremity. Journal of Hand Surgery. 1987; 12A: 931-935.
  • 22. Hadler NM. Illness in the workplace: the challenge of musculoskeletal symptoms. Journal of Hand Surgery. 1985; 10A: 451-456.
  • 23. Mooney V. Overuse syndromes of the upper extremity: Rational and effectivetreatment. Journal of Musculoskeletal Medicine. 1998 Aug; 15(8):11-18.
  • 24. Wand JS. Carpal Tunnel Syndrome in Pregnancy and Lactation. The Journal of Hand Surgery. 1990; 15B: 93-95.
  • 25. Stolp-Smith KA, Pasco MK, Ogburn PL Jr. Carpal tunnel syndrome in pregnancy: frequency, severity, and prognosis. Archive of Physical Medicine Rehabilitation. 1998 Oct; 79(10): 1285-7.
  • 26. Wright PE. Carpal tunnel and Ulnar Tunnel Syndromes and Stenosing Tenosynovitis. In: Crenshaw AH, Milford L, editors. Campbell's Operative Orthopaedics. Mosby: St.Louis, 1988:3435-3444.
  • 27. Stallings SP, Kasdan ML, Soergel TM, Corwin HM. A Case-control study of obesity as a risk factor for Carpal Tunnel Syndrome in a population of 600 patients presenting for independent medical examination. Journal of Hand Surgery. 1997; 22A: 211-215.
  • 28. Lam N, Thurston A. Australia-New Zealand Journal of Surgery. 1998 Mar; 68(3): 190-193.
  • 29. Kaplan SJ, Glickel SZ, Eaton RG. Predictive factors in the non-surgical treatment of carpal tunnel syndrome. Journal of Hand Surgery. 1990 Feb; 15B: 106-108.
  • 30. Luchetti R, Schoenhuber R, Alfarano M, Deluca S, DeCicco G, Landi A. Serial overnight recordings of intracarpal canal pressure in carpal tunnel syndrome patients with and without splinting. The Journal of Hand Surgery. 1994; 19B:35-37.
  • 31. Destefano F, Nordstrom DL, Vierkant RA. Long-term Symptom Outcomes of Carpal Tunnel Syndrome and Its Treatment. The Journal of Hand Surgery. 1997 Mar; 22A(2):200-209.
  • 32. Weiss APC, Sachar K, Gendreau M. Conservative Management of Carpal Tunnel Syndrome: A Reexamination of Steroid Injection and Splinting. The Journal of Hand Surgery. 1994; 19A:410-415.
  • 33. Banta, CA. A Prospective, Nonrandomized Study of Iontophoresis, Wrist Splinting, and Antiinflammatory Medication in the Treatment of Early-Mild Carpal Tunnel Syndrome. Journal of Medicine. 1994 Feb; 36(2):166-168.
  • 34. Garfinkel MS, Singhal A, Katz WA, Allan DA, Reshetar R, Schumacher HR. Yoga-Based Intervention for Carpal Tunnel Syndrome. The Journal of American Medicine Association. 1998 Nov 11; 280(18):1601-1603.
  • 35. Seradge H, Jia Y, Owens W. In Vivo Measurement of Carpal Tunnel Pressure in the Functioning Hand. Journal of Hand Surgery. 1995 Sept; 20A(5):855-859.
  • 36. Kruger VL, Kraft GH, Deitz JC, Ameis A, Polissar L. Carpal tunnel syndrome: objective measures and splint use. Archives of Physical Medicine Rehabilitation. 1991 June; 72: 517-520.
  • 37. Palmer DH, Hanrahan LP. Social and economic costs of carpal tunnel surgery. Instructional Course Lecture (IFC). 1995; 44:167-72.
  • 38. Amadio PC. The First Carpal Tunnel Release? The Journal of Hand Surgery. 1995; 20(B):1:40-41.
  • 39. Rosenbaum RB. Carpal tunnel syndrome and other disorders of the median nerve. Butterworth-Heinemann: Stoneham, 1993.
  • 40. Jimenez DF, Gibbs SR, Clappers AT. Endoscopic treatment of carpal tunnel syndrome: a critical review. Journal of Neurosurgery. 1998 May; 88:817-826.
  • 41. Nathan PA Meadows KD, Keniston RC. Rehabilitation of Carpal Tunnel Surgery Patients Using a Short Surgical Incision and an Early Program of Physical Therapy. The Journal of Hand Surgery. 1993 Nov; 18A(6):1044-1050.
  • 42. Einhorn N, Leddy JP. Pitfalls of Endoscopic Carpal Tunnel Release. Orthopedic Clinics of North America. 1996 April; 27(2):373-379.
  • 43. Chow JCY. Endoscopic Release of the Carpal Ligament: A New Technique for Carpal Tunnel Syndrome. Arthroscopy: The Journal of Arthroscopic and Related Surgery. 1989; 5(1):19-24.
  • 44. Agee JM, McCarroll HR Jr, Tortosa RD, Berry DA, Szabo RM, Peimer CA. Endoscopic release of the carpal tunnel: A randomized prospective multicenter study. The Journal of Hand Surgery. 1992 Nov; 17A(6):987-995.
  • 45. Palmer DH, Paulson JC, Lane-Larsen CL, Peulen VK, Olson JD. Endoscopic Carpal Tunnel Release: A Comparison of Two Tenchniques with Open Release. Arthroscopy: The Journal of Arthroscopic and Related Surgery. 1993; 9(5):498-508.
  • 46. Lee H, Jackson TA. Carpal Tunnel Release Through a Limited Skin Incision under Direct Visualization Using a New Instrument, the Carposcope. Plastic Reconstruction Surgery. 1996 Aug; 98(2):313-319.
  • 47. Cook AC, Szabo RM, Birkholz SW, King EF. Early Mobilization Following Carpal Tunnel Release. The Journal of Hand Surgery. 1995 Apr; 20B(2):2:228-230.
  • 48. Palmer AK, Toivonen DA. Complications of endoscopic and open carpal tunnel release. The Journal of Hand Surgery. 1999 May; 24(3):561-565.
  • 49. Hulsizer DL, Staebler MP, Weiss AP, Akelman E. The results of revision carpal tunnel release following previous open versus endoscopic surgery. Journal of Hand Surgery. 1998 Sep;23(5):865-9.
  • 50. Feuerstein M, Burrell L, et al. Clinical management of carpal tunnel syndrome: a 12-year review of outcomes. American Journal of Industrial Medicine. 1999; 35(3):232-245.
  • 51. Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, et al. A Self-Administered Questionnaire for the Assessment of Severity of Symptoms and Functional Status in Carpal Tunnel Syndrome. The Journal of Bone and Joint Surgery. 1993 Nov; 75A(11):1585-1592.