Crafts Glenn J, Snow Gregory J, Ngoc Kim Hong
Private Practice, San Jose, CA.
J Chiropr Med. 2011 Sep;10(3):166-72. doi: 10.1016/j.jcm.2011.01.004. Epub 2011 Jun 24.
Work-related upper limb disorder (WRULD) encompasses a broad array of occupational upper limb injuries, the most common being carpal tunnel syndrome (CTS). Carpal tunnel syndrome occasionally presents with concomitant ganglion cysts. The purpose of this case report is to describe the chiropractic management of a patient with bilateral WRULD complicated by ganglion cysts.
The patient was diagnosed previously with bilateral CTS and presented with common CTS symptoms that were nonresponsive to several previous courses of care. Magnetic resonance imaging revealed bilateral ganglion cysts, and electrodiagnostic studies found left CTS and bilateral radial neuralgia. Right limb findings appeared more consistent with nonspecific arm pain.
Chiropractic manipulative therapy, soft-tissue approaches, and physiotherapy modalities were applied to the arms and wrists over a 3-month period. Home care included exercises using elastic tubing and a gyroscopic handheld device. Chiropractic manipulative therapy and other conservative approaches resulted in subjective improvements of decreased hand paresthesias and muscle weakness and objective improvements in range of motion and neurologic deficits. Although the patient's symptoms and function improved, she remained with a level of permanent impairment.
This case demonstrates successful chiropractic management of a patient with WRULD complicated by ganglion cysts. Further larger-scale studies are recommended to determine if chiropractic management demonstrates positive outcomes for this condition.
工作相关上肢疾病（WRULD）涵盖一系列职业性上肢损伤，最常见的是腕管综合征（CTS）。腕管综合征偶尔会伴有腱鞘囊肿。本病例报告的目的是描述一名双侧WRULD并发腱鞘囊肿患者的整脊治疗情况。
该患者先前被诊断为双侧CTS，表现出常见的CTS症状，对先前的几个疗程治疗均无反应。磁共振成像显示双侧腱鞘囊肿，电诊断研究发现左侧CTS和双侧桡神经痛。右侧肢体的表现似乎更符合非特异性手臂疼痛。
在3个月的时间里，对双臂和手腕进行了整脊手法治疗、软组织治疗和物理治疗。家庭护理包括使用弹力管和手持陀螺仪设备进行锻炼。整脊手法治疗和其他保守方法使手部感觉异常和肌肉无力的主观症状有所改善，活动范围和神经功能缺损也有客观改善。尽管患者的症状和功能有所改善，但仍存在一定程度的永久性损伤。
本病例证明了整脊疗法对一名WRULD并发腱鞘囊肿患者的成功治疗。建议进一步开展更大规模的研究，以确定整脊疗法对这种疾病是否能产生积极效果。
