TECHNOLOGY AND HOW WE USE IT TO DAMAGE OURSELVES WILLIAM A. DELP, DO ASSISTANT PROFESSOR OF OMM GA PCOM

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1 TECHNOLOGY AND HOW WE USE IT TO DAMAGE OURSELVES WILLIAM A. DELP, DO ASSISTANT PROFESSOR OF OMM GA PCOM

2 OBJECTIVES Understand how we interact with technology new and old Understand how injury occurs Texting Thumb Carpal Tunnel syndrome diagnosis and OMM treatment De Quervain s tendenitis Diagnosis and treatment Upper Crossed Syndrome Diagnosis and treatment

5 KEYBOARD

9 TEXTING THUMB

10 SYMPTOMS Soreness and possibly cramping in the hand Also known as blackberrry thumb, smart phone thumb, or Nitendo thumb Not likely to cause permanent damage, but the evidence suggests that osteoarthritis is a possibility as the population ages Treatment is to just give the hand a rest! In some cases De Quervain s tendinitis can occur

11 CARPAL TUNNEL SYNDROME Symptoms Numbness Paresthesia Pain Atrophy of intrinsic muscles In the distribution of the Median nerve

12 CARPAL TUNNEL SYNDROME Symptoms Discomfort is worse at night There may be hyperesthesia in the involved areas Pain may refer retrograde to the elbow, shoulder or neck

13 CARPAL TUNNEL SYNDROME

14 CARPAL TUNNEL SYNDROME Physical Findings Atrophy of the thenar eminence in advanced cases.

15 CARPAL TUNNEL SYNDROME Physical Findings Tinel Sign for the Median nerve Percussion of the median nerve in the carpal tunnel on the radial side of the palmaris longus tendon; produces paresthesias in the distribution of the nerve

16 CARPAL TUNNEL SYNDROME Physical Findings Phalen Test Wrists flexed, hands held back to back as shown. Positive if symptoms reproduced prior to one minute in this position

17 CARPAL TUNNEL SYNDROME Physical Findings Wrist Neutral Test Fists are compressed together with wrists at neutral If symptoms are reproduced this indicates the presence of malingering

18 CARPAL TUNNEL SYNDROME EMG/NCV Nerve Conduction Velocity measured across the carpal tunnel will show delayed latency of the median nerve. Test is diagnostic and also gauges the severity of the nerve compression.

19 OSTEOPATHIC MANIPULATIVE TREATMENT Direct Myofascial Release / Muscle Energy Developed by Ben Sucher, DO PM&R Specialist Carpal Tunnel Technique Transverse Carpal Ligament Release Both these techniques have been demonstrated to improve neural function on NCV studies and to increase the diameter of the carpal tunnel on MRI

20 MRI EVIDENCE BEFORE Tx AFTER Tx

21 SUCHER TECHNIQUES

22 SUCHER TECHNIQUES This next technique works by pulling the thicker proximal portion of the tendons of the finger flexors into the tunnel, thereby dilating the tunnel from within like a bougie.

23 SUCHER TECHNIQUES

24 CARPAL TUNNEL SYNDROME TREATMENT OMT Treatment directed to the thoracic inlet & outlet improves venous and lymphatic drainage of the arm. Compromise of this drainage is believed to be the mechanism behind pregnancy induced CTS Once the baby is delivered, the CTS is cured

25 CARPAL TUNNEL SYNDROME TREATMENT OMT Treatment directed to somatic dysfunction at C5, C6, C7 & T1 is done to remove somatosomatic reflex neurotrophic effects

26 CARPAL TUNNEL SYNDROME TREATMENT Wrist Splints worn each Night Still done, but never shown to be effective NSAIDs Only work if cause is overuse with tendon sheath edema Vitamin B6 100 mg tid Not a research proven treatment, but empiric evidence supports it

27 CARPAL TUNNEL SYNDROME INJECTION OF CORTICOSTEROIDS

28 CARPAL TUNNEL SYNDROME Surgical Decompression Surgery is indicated in patients who have constant numbness and tingling in their fingers. Symptoms that persist for more than one year. Thenar atrophy or weakness Sensory Loss Fibrillation potentials on EMG/NCV

29 FINDINGS There was no difference between outcomes for either surgical or conservative care at the three month interval. Surgical treatment has a superior benefit, in symptoms and function, at six and twelve months. Patients undergoing surgical release were two times more likely to have normal nerve conduction velocity studies.

30 DE QURVAIN S TENDENITIS

31 CAUSES AND RISK FACTORS Repetitive motion (texting?) Chronic grasping or pinching objects causes inflammation of the tendon sheath resulting in thickening of the sheath Injury from direct trauma Arthritis Age (could change as the tech dependent population ages) Pregnancy and is more common in females

32 SYMPTOMS Pain and swelling at the dorsal base of the thumb Difficulty and pain moving the wrist and thumb in grasping or pinching objects Sticking much like a trigger finger

33 DIAGNOSIS FINKELSTEIN S TEST

34 EICHHOFFS S TEST

35 TREATMENT Steroid injection provides relief in 50% of patients Surgery OMM- Counterstrain may help

36 UPPER CROSS SYNDROME

38 MECHANICS Forward head posture results in tightening of the posterior cervical muscles Muscles of the anterior chest shorten resulting in increased stress on the rhomboids, levator and trapesius

39 SYMPTOMS Headaches and neck pain TMJ due to tension on the temporalis m. Back pain- mostly thoracic Thoracic outlet syndrome ( most likely presenting as tingling over ulnar nerve distribution) Cervical nerve root compression is possible

40 STRUCTURAL FINDINGS TO LOOK FOR Cervical segmental dysfunctions First rib dysfunctions primarily on the right (reaching for the mouse) Upper and middle thoracic segmental dysfunctions (usually rotated left) Lumbar segmental dysfunctions are also possible depending on posture and ergonomics

41 MANAGEMENT Correct Osteopathic structural findings after complete structural and neurologic assessment Correct postural problems- stretches and strengthening exercises for upper back Advise regarding correct ergonomics

45 STANDING DESK

46 UPPER TRAPEZIUS STRETCH Flex Sidebend away Rotate toward

47 STERNOCLEIDOMASTOID STRETCH Extend Sidebend away Rotate toward

48 LEVATOR SCAPULAE Flex Sidebend away Rotate away

49 PECTORALIS MAJOR AND MINOR Doorway stretch

50 SCALENE Posterior Middle Anterior Rotate away No rotation Rotate toward For all sidebend away

51 QUESTIONS

Lowe Plastic Surgery (LPS)

Lowe Plastic Surgery (LPS) PATIENT EDUCATION FOR: CUMULATIVE TRAUMA DISORDER THE PROBLEM: There has been a remarkable increase in what is termed cumulative trauma disorder (CTD) in the last 20 years. Other