Journal of Manipulative and Physiological Therapeutics
Case reportA suspected case of ulnar tunnel syndrome relieved by chiropractic extremity adjustment methods
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.
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Chiropractic management of a patient with ulnar nerve compression symptoms: A case report
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