AppalachianPT: Facts Regarding Carpal Tunnel Syndrome

May, 2020



INSIDE: • Treating Carpal Tunnel Syndrome • Exercise Essentials • Patient Success Spotlights • Leaders & Hope

May, 2020



Whether you have pain or have been suffering for a long time, seeing a physical therapist at Appalachian Physical Therapy, Inc. can help you return to a more active and pain-free life. Give us a call at: • Broadway: 540-901-9501 • Harrisonburg: 540-209-8977 • Pinehurst: 910-215-0541 You see most of the studies done or performed use older technology involving standard sensory conduction techniques in the electrodiagnosis of carpal tunnel syndrome (CTS). This would be great if this was the best we could do. But there are many ways to perform these studies and some much better than others 1-2 . Unfortunately the patient is usually left in the dark when it comes to explaining the outcomes and are usually told they need surgery because the studies that were performed indicated the same. OK so how about a little English here please. There are so many things that can mimic CTS with numbness into your hand and fingers. Even some of the diagnostic tests that have been used for decades have been shown to have poor diagnostic capability. This is one of the reasons here in Virginia, worker’s compensation (WC) insurance does not recognize it as an entity unto itself. Sometimes the tests done to help with diagnosing are misleading finding normal abnormalities that occur in the general population 3 . It should be pretty obvious we do not just use our arms and hands at work. They are used constantly with everything we do.

Recently I had a patient come into our office with a diagnosis of Carpal Tunnel Syndrome (CTS) and was scheduled for surgery. She had already had a nerve conduction velocity (NCV) test and decided she wanted to try a chance with physical therapy while she was waiting for her surgery to be rescheduled from being cancelled due to COVID-19. Her symptoms had been coming and going for a little over 2 years and were gradually getting worse. She actually came to us at the recommendation from two of her friends that had received treatment here previously. She stated we had made a life changing event in their lives and she wanted to try and see if we could produce the same for her. Life changing? This was already shaping up to be challenging. CTS is exactly what it says; a syndrome. A syndrome is a collection or group of symptoms that have been associated or occur together. Now CTS is defined as a painful condition of the hand and fingers caused by compression of a major nerve where it passes over the carpal bones through a passage at the front of the wrist, alongside the flexor tendons of the hand. It may be caused by repetitive movements over a long period, or by fluid retention, and is characterized by sensations of tingling, numbness, or burning. There you have it, pretty cut and dry. But it is far from the truth!

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So back to my gal who showed up at our office with numbness and tingling in her hands for 2 years. She had several preceding problems with her neck and upper extremities that led me in checking out those areas as the nerves and tissues associated with those structures are all connected further down the chain. In fact, there are several muscles themselves which can refer pain into the thumb and first two fingers giving one the exact perception they indeed have CTS. One of them, the subclavius is shown here for you. There are several more. After my evaluation, I found she had significant problems with her neck for almost 20 years when she

Now everyone does not experience this from one, two or even three sessions of PT but we have seen it so many times, a person would be doing themselves a disservice from not checking out options other than jumping into and having surgery for this syndrome. Let there be no doubt, there are specific times when surgery for CTS is warrented. Before that happens to you, do yourself a favor and call us for an evaluation to see if we can make a life changing event happen for you. 1)J Clin Neurophysiol. 2011 Feb;28(1):45-50. doi: 10.1097/WNP.0b013e31820510f2. How to make electrodiagnosis of carpal tunnel syndrome with normal distal conductions? Lee WJ1, Liao YC, Wei SJ, Tsai CW, Chang MH. 2)Clin Neurophysiol. 2006 May;117(5):984-91. Epub 2006 Mar 23. Comparison of sensitivity of transcarpal median motor conduction velocity and conventional conduction techniques in electrodiagnosis of carpal tunnel syndrome. Chang MH1, Liu LH, Lee YC, Wei SJ, Chiang HL, Hsieh PF.

landed on her neck when a horse she was riding tripped and tried to fall on her. She also had a previous surgery of one of her shoulders due to it being dislocated several times beforehand. Her other shoulder also had previous problems with subluxation (medical term for partial dislocation). So I elected to treat her cervical (neck) as well as her shoulder problems using deep soft tissue massage as well as Stecco fascial manipulation ® . I informed her she would probably be sore and the treatment could indeed make her symptoms worse temporarily. I saw her in one week for a follow-up visit. I was immediately dissapointed when she informed me she did not experience any increased symptoms. Not that I was hoping for more numbness or tingling but usually a person has a fair amount of soreness if we are going to make a change. She then smiled and stated her symptoms were altered/changed 100% up until the day she returned and were only mild in comparison. Holy smokes!! What a change.

3)2005 Journal of Neurology Neurosurgery and Psychiatry How to get the most out of nerve conduction studies and electromyography G Fuller

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“I will definitely recommend!” “When I first started coming to APT, I had lots of pain. As things went along, I started to improve and now I have ZERO pain! Annie was really good at keeping me informed and getting me back to the things I wanted to do. Great staff all around. I will definitely recommend! Connie was also very helpful and even called me to remind me of my appointments.” - Jack L.

“I would have never identified this as a problem without her expertise.” “I came to Appalachian Physical Therapy when referred by my GYN as an option before trying surgical intervention. Colleen identified residual issues from an ACL repair 3 years prior that were causing pain in other areas. I would have never identified this as a problem without her expertise and as a result, I was able to avoid surgical intervention. I am so thankful for APT’s services.” - Mariah M. “Over a period of weeks, the pain lessened dramatically.” “Before going to APT I had pain from my hip to my ankle for 4 months, ranging from moderate pain to actual limping. In 2007, I had a partial hip replacement because of a black ice accident. All was really trouble free and I have been very active, until last summer when a 3 week road trip took its toll. Long days in the car followed by very active days, etc., resulted in much pain. This greatly limited my long early morning walks which I love. A friend referred me to APT and I went not knowing what else to do. Linden listened attentively and was very knowledgeable about what would help. She began a round of stretches, exercises and pressure point therapy (ouch!). Over a period of weeks, the pain lessened dramatically. I will certainly continue the stretching exercises she has prescribed. I thank her sooo much for all her help and I have resumed my morning walks. The APT staff are clearly doing a great job.” - M. Curtis


Who is the Workshop For? The Rotator Cuff Workshop is for people suffering with shoulder pain. The Hip and Knee Seminar is for individuals having difficulty walking or having pain in either joint. If you are looking to feel normal again and heal naturally without medications, injections and surgery, don’t delay! Register today! Use the camera app on your smartphone to see the next workshop at the location nearest you. You may also call our office numbers listed on the front page of this newsletter. REVEALING HOW TO GET BACK TO NORMAL WITHOUT MEDICATIONS, INJECTIONS & SURGERY...

The workshops belowhave been canceled for themonth of May

and are tentatively scheduled for June at each location








This comes tomy title of leaders and hope. You see, leaders come in all sizes, genders and nationalities. A lot of them we walk by and don’t even notice until later on when something they said or did reminds us of their leadership. Leaders have to stand up to those who will try and tear them down because they themselves want to be the top dog. Instead of working alongside and encouraging the leader, they will want to sling arrows at them criticizing them for anything and everything. Remember I stated this crisis as well as others gives folks the opportunity to fall either on the high road or the low road. Well, we unfortunately have seen those who have taken the low road as well. This opportunity we have in front of us is just that, a chance to look at where we are and to make an appropriate change for the better. It is essentially up to us as a citizen of this great nation to determine our response and where we go fromhere. I am a big history buff and during the early 1940’s, this nation overcame a great power that could have changed the world

People are saying so many things about COVID-19 today and we are only into this 4 weeks. It looks like we have at least until the end of May before we begin venturing out from our places of safety. It could be a little sooner however we all need to be extra vigilant to prevent a kickback effect. Before I go any further, I want to say a special thank you to a fabulous staff who has continued to treat folks on a daily basis from each of our locations. We continue to get notes and cards and words of thanks from our patients that have been served through this crazy time. It is because of you that we have been able to endure this hardship. It has not been easy to say the least for any of us so we say a special thanks to you, our patients for trusting us and our places of business. We have been diligent in cleaning and cleaning and cleaning. I know some of our staff have chaffed hands from all the gloves, cleansers, hand washing and washing and the list goes on.

as we know it today. All of us became united under our stars and stripes and participated to make the outcome what it was. Our manufacturing capability was like nothing ever seen and still unsurpassed to this day. I believe this crisis will alert us that we need to bring back our manufacturing jobs here in this country. I also think we will see the media have less control of this country and folks will become more involved with each other instead of their cell phones. I could go on and on but I remain hopeful that we will see this country live up to our name, The UNITED States of America! Now before I leave you I want to show you some real leaders who continue to spread HOPE that will help us find our footing if we let them. These kids and their artwork in this article are found in Juneau, Alaska. They have decided to decorate the town with hope through all of their window painting, sidewalk chalk and many decorations. They ARE our leaders showing us how tomake the world a better place. They certainly give me HOPE! Pray for them and this nation; one nation, under God with liberty and justice for all!

I have statedmany times through this we were going to see the good and the bad in this situation and in folk’s reactions. I am sure many of you would agree that this is the case. We have seen gouging prices as well as hoarding of supplies. Some hospitals as well as health care facilities were running out of very simple things like toilet paper. Never figured that one out. I have also seen acts of grace, courage and giving that surpass all understanding. I have read of people turning down a ventilator to allow a younger person or one with children the chance to survive.

I have read acts of folks paying for thousands of dollars of groceries for those with less ability to pay. And I personally know of many folks who are on their knees daily praying for this country, the world and me and you. A PATIENT’S GRATITUDE


Thinking of you. To staff and therapists at Appalachian PT, Broadway. Being aware of the risks faced by all healthcare providers in this time with COVID-19, I want to express my gratitude for the care you’ve provided me in the past during periods of back and hip/thigh pain. Most recently for BPPV. My life is so much better after these problems were treated and resolved. Thank you! And my very best, warmest wishes for each of you to stay safe and healthy during these perilous weeks and months.

At Appalachian Physical Therapy, you will receive hands-on therapy treatments by our friendly, caring health experts during focused and individualized sessions. It’s time to get Appalachian Physical Therapy if: • You’re tired of living in pain • You want to feel better and move better • You have been in an auto accident or injured on the job • You want to prevent injury

1. Call and talk to a therapist 2. Discover why your pain has come back 3. Get your custom recovery program

Sinerely, Susan M.

EXERCISE ESSENTIALS Try these exercises to keep you moving... WAND SHOULDER FLEXION Lying on your back and holding a wand, palms face down on both sides, slowly raise the wand towards overhead. Repeat 5 times.

MAKE PAYMENTS ON OUR WEBSITE! Appalachian PT gives patients the option to pay online using our website. All payments are totally encrypted for security. Select the “Pay” tab at the top of the page. It’s just that easy.

Strengthens Shoulders

ELASTIC BAND EXTERNAL ROTATION While holding an elastic band at your side with your elbow bent, start with your hand near your stomach and then pull the band away. Keep your elbow at your side the entire time. Repeat 6 times.

Strengthens Wrists

Exercises copyright of

Always consult your physical therapist or physician before starting exercises you are unsure of doing.

Why You Need To Come In For Another Check-Up:

� Move without pain � Bend and move freely � Balance confidently & securely

� Sit for long periods comfortably � Walk for long distances � Live an active & healthy lifestyle


BROADWAY CLINIC 540-901-9501



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