Case report
A suspected case of ulnar tunnel syndrome relieved by chiropractic extremity adjustment methods

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Abstract

Background

There has been little published about ulnar tunnel syndrome (UTS) as it relates to the practice of chiropractic, despite chiropractors' apparent interest in nerve compression syndromes and a growing trend toward providing chiropractic extremity care. This syndrome is not very common and could be mistaken for carpal tunnel syndrome by practitioners who are not aware of the differences.

Objective

To discuss the case of a patient with ulnar tunnel syndrome whose symptoms were resolved by chiropractic extremity adjustment.

Clinical features

A 45-year-old female patient complained of numbness in her little finger. Standard orthopedic testing procedures for the wrist and hand reproduced the symptom, but tests for the cervical spine and thoracic outlet region were negative.

Intervention and outcome

Care for this patient consisted of adjustment procedures directed to the wrist, primarily the hamate and pisiform articulations with the triquetrum. Her symptoms were resolved in 4 office visits, with corresponding improvement in examination findings.

Conclusions

This case report represents what a patient could expect during a typical chiropractic treatment. The examination and the care given were simple and cost-effective but might not be sufficient for a more complicated or persistent case. The costs for the care in this case were borne solely by the patient and were affordable. Hard conclusions cannot be reached without more sophisticated diagnostic procedures, additional similar cases, and controlled research conditions.

Introduction

A compression syndrome of the hand involving the ulnar nerve has been recognized and described in the scientific literature.1 Usually called ulnar tunnel syndrome (UTS), it may be mistaken for the far more common carpal tunnel syndrome (CTS). It is similar to CTS in that patients suffering from ulnar nerve compression may complain of finger numbness or pain, but typically UTS affects the little finger and possibly ring finger, whereas CTS affects the thumb, index, and middle fingers. Despite chiropractors' apparent interest in nerve compression syndromes, as well as a growing trend toward chiropractic extremity care, there appear to be only 2 references in the chiropractic literature for this particular syndrome: a clinical advice article in a national association magazine2 and a description of the syndrome in a popular textbook.3 Regardless of the individual Doctor of Chiropractic's preferred technique methods or philosophy, it is important that the doctor recognize the syndrome to either be able to better target the problem or refer to another practitioner. The case illustrated below represents an approach that is appropriate for a typical chiropractic office, where sophisticated diagnostic equipment may not be practical or necessary for a nontraumatic case of low severity.

Section snippets

Case report

A 45-year-old woman complained of numbness and occasional tingling in her right little finger. The symptom had begun about 2 weeks earlier and was constant. The medial side of the finger, along the entire length, was most affected, and no other fingers were involved. She had not noticed any weakness and could not identify any particular cause for her problem. It bothered her because in her job as an accountant, she was in the habit of resting the ulnar side of her hand on her computer keyboard

Discussion

The ulnar tunnel (also known as Guyon's canal) lies at the level of the proximal carpal bones along the ulnar border. The transverse carpal ligament (TCL), or flexor retinaculum, forms the floor of the tunnel, with the aponeurosis of the flexor carpi ulnaris muscle forming the roof (Fig 3). The ulnar border is formed by the pisiform; the tunnel is triangular in shape and the radial border is defined where the FCU aponeurosis attaches to the TCL. The radial border is often described incorrectly

Conclusion

The above case is probably not unique, nor even unusual, for a chiropractic practice. There are many anecdotal reports of patients coming in with similar symptoms for which the Doctor of Chiropractic in general practice may not have had the expertise to make a specific diagnosis. The effects of chiropractic adjustments seem, in many cases, to be general enough that many symptoms will clear up with care—or perhaps on their own, with time—despite the lack of a specific approach, fortunately for

Acknowledgements

Kathryn Hoiriis, DC, Clifford Smith, PhD, and Charles Lantz, PhD, DC, gave indispensable advice throughout this case and writing of the paper. D. Wayne Boylston, MS, DC, and Brandon Crouch assisted with the photograph in Figure 1. Carla Burton of the Life University Multimedia Lab and Katharine Russell of Georgia Tech assisted in processing the images in Fig 3, Fig 4.

References (22)

  • R.C. Schafer et al.

    Motion palpation and chiropractic technic

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