Abstract
Carpal tunnel syndrome (CTS) is a common nerve compression syndrome that includes symptoms of numbness and tingling in the median nerve distribution. Medical cupping therapy has been used for managing a variety of medical conditions, but, to the author's knowledge, the cupping device has not been directly applied over the carpal tunnel as a form of treatment. This case report involves a 27-year-old woman who presented with symptoms of CTS in the right hand and palpatory restriction over the right carpal canal. Electrodiagnostic testing confirmed mild CTS, and neuromuscular ultrasonography revealed a mildly enlarged median nerve at the wrist, which was also consistent with CTS. The patient was taught to use a cupping device that would allow her to apply suction over the ventral wrist daily. The patient noted improvement over several weeks and was asymptomatic at her 3-month follow-up visit. Repeated testing revealed that initial abnormalities in the wrist had resolved. Suction decompression of the carpal tunnel may be a viable alternative treatment for patients with mild CTS.
Carpal tunnel syndrome (CTS) is widely recognized as the most common nerve compression syndrome.
1-3 Although there are several known causes of CTS,
4-10 the pathomechanics involved at the wrist have been more thoroughly elucidated over the past decade.
11-13 These studies
11-13 have proposed a multifactorial mechanism involving the following 6 aspects: (1) increased intracarpal pressure, which compresses the median nerve; (2) decreased median nerve mobility due to relative fibrous fixation as a result of chronic inflammation and edema; (3) median nerve deformation from compression, traction, or stretching; (4) increased stiffness of the synovium and flexor retinaculum (transverse carpal ligament [TCL]); (5) thenar muscle hypertrophy or increased muscle mass, which intrudes into the carpal tunnel during hand activity at the same time the flexor tendons are tightening, thus compressing the median nerve in between the muscle ventrally and tendons dorsally; and (6) flexor tendon thickening due to chronic inflammation, edema, and fibrous changes in the tendon sheaths.
11-13 Consequently, treatment directed at any of these contributing factors in patients with CTS could potentially lead to some degree of improvement. Typically, patients with CTS have limited choices among standard nonsurgical treatments or the more invasive surgical release.
4-6 This case involves a novel and simple nonsurgical approach that may address mechanisms 1 and 4 (intracarpal pressure and stiffness in the TCL). The theory involves use of a suction device to apply negative pressure directly over the carpal tunnel to decrease intracarpal pressure, which would alleviate median nerve compression. Medical cupping has been used for other conditions and in patients with CTS, but, to my knowledge, the suction has not been previously applied directly over the carpal tunnel to achieve the desired effects as described in the present report.
14,15
Suction decompression of the carpal tunnel may provide a viable alternative treatment option for patients with mild CTS. It has the added benefit of being self-administered, which puts the patient in charge of his or her own treatment and outcome. Precautions are recommended to limit the time of use and the degree of suction induced, and particularly to closely observe the skin at the application site to avoid tissue damage from excess suction. Further studies are recommended with a large number of patients and with varying degrees of CTS severity. Suction decompression may also be a valuable adjunct to use in conjunction with other routine treatments for patients with CTS, such as wrist orthoses, stretching exercises, OMT, activity modification, topical anti-inflammatory medication, and steroid injections.