History and Subjective Complaints
53-year-old male factory worker/forklift operator complains of bilateral hand numbness, burning, tingling and loss of grip strenth in the thumb, index and ring fingers, bilaterally. Nocturnal aggravation of the hands resulted in a workers compensation case. Over the course of 9 years, the patient failed operative recovery: 4 left CTS surgeries, 3 right CTS surgeries and, subsequently, failed 2 ulnar nerve transposition surgeries. Company safety personnel refers patient to Dr. Mally.
Objective Findings
Carpal ligamentous instability, scar tissue proliferation at the palmar crease, bilaterally, decreased sensation on aesthesiometer, 2-point discrimination and depth perception, decrease in bilateral grip strength, positive bilateral Tinel’s, Phalen’s, Wormser’s and Median Nerve compression test. Nerve Conduction Velocity’s (NCV) positive; bilateral median nerve latencies.
X-Ray
Radiographic carpal tunner projection (X-POSERtm) revealed left 66% carpal tunnel occlusion and right 75% carpal tunnel occlusion.
Diagnosis
Bilateral Carpal Instability; Bilateral Carpal Tunnel Syndrome; Bilateral Carpal Subluxation.
Treatment
Specialized manipulative decompression of involved carpals bilaterally (Mally Technique), 2 weeks of intensive care with cold laser (830-850 nm).
Nutrition
Anti-inflammatory vitamins (bromelain, papain, trypsin, chymotrypsin, bioflavonoids) and vitamin B6.
Rehab
6 weeks of reconstruction and work hardening.
Addendum
Failed post-op CTS is very high with connective tissue hyperplasia the highest cause of failure. Misdiagnosis leads to erroneous results and, in this case, perfmanent disability and loss of employment. According to the patient, after a short 5 treatments by Dr. Mally, he reports a 98% improvement in feeling and strength. At MMI (Maximum Medical Improvement), no residuals and returns to gainful employment.
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