ELECTROCEUTICAL TREATMENT

AND THE RESOLUTION OF

COMPRESSION / ENTRAPMENT NEUROPATHY

Cumulative Trauma Disorders: Carpal Tunnel Syndrome

R. Sorgnard, Ph.D., J. Woessner, M.D., Ph.D., M. Robertson, M.D.

CLINICAL ELECTROMEDICAL RESEARCH ACADEMY

Abstract
Compression of the median nerve within the carpal tunnel is the most common entrapment
neuropathy and represents nearly 50% of all occupational injuries. At present, the definitive
treatment for this condition is decompression of the nerve by surgical division of the transverse
carpal ligament. Specific-parameter bioelectric treatment was utilized in 133 patients presenting with
moderate-to-severe Cumulative Trauma Disorders (CTD), specifically Carpal Tunnel Syndrome
(CTS). Complete or partial resolution of symptoms was achieved in 79% (105) of the patients
without surgical intervention.

Introduction
The median nerve contains contributions from C5-T1 spinal nerve roots and is formed from the lower
trunk of the brachial plexus. It lies medially in the upper arm, crosses the elbow anteriorly and in the upper
forearm usually passes between the two heads of the pronator teres, although its relationship to this muscle
is variable.1 At the wrist, the median nerve passes, along with the flexor tendons, under the transverse
carpal ligament, which forms the roof of the carpal tunnel. In the hand, the median nerve innervates four
intrinsic hand muscles - the abductor pollicis brevis, opponens pollicis, and the first lumbrical muscles.

Compression of the median nerve within the carpal tunnel is the most common entrapment neuropathy.
The dominant hand is the first and most severely affected but CTS is often bilateral and typically affects
more women than men,2 CTS is caused by compression of the median nerve as it passes through the wrist.
This occurs when the area of the carpal tunnel is reduced or narrowed by wrist flexion or swelling of the
flexor tendons of the fingers, increasing the susceptibility of the nerve to pressure. Occasionally, there is
no apparent cause and these patients may have congenitally narrow carpal tunnels with compression
developing from normal degenerative changes in the synovial membranes and other structures within the
tunnel.3 Improved technology in imaging with diagnostic ultrasound and MRI should increase the number
of differentiated, identifiable causes in patients with otherwise idiopathic CTS.4

According to the Bureau of Labor Statistics and the National Institute of Occupational Safety and
Health, CTS has long been associated with occupations involving repetitive movements of the hands and
fingers. Specific biomechanical studies have shown that pressures within the carpal tunnel are increased
substantially during wrist flexion, especially when the fingers were flexed simultaneously in a pinching-
type movement.5, 6, 7 CTS frequently occurs in occupations that offer little relief from repetitive motion
movement or job that requires a force exceeding 8-12 pounds It is postulated that it is repetitive motion
without adequate recovery time that causes the inflammation and tunnel area reduction. A research study
from the University of Michigan found that the use of more than 8 or 9 repetitions per minute did not allow
the wrists sufficient time to produce enough lubricating fluid (Barrier, 1991).
 CTS is characterized by bouts of pain and paresthesia in the wrist and hand, often occurring during
sleep or on waking and symptoms are usually worsened by using the hands. Pain often spreads to the
fingers, arm, or the shoulder, but the paresthesias is localized to the palmar aspect of the fingers.8, 9, 10 CTS
is considered a class 2 type nerve injury, characterized by axonal interruption, with intact connective tissue
framework maintained. The physiological features of CTS (chronic compression / entrapment neuropathy)
are still not clearly understood, but it is believed that demyelination initially occurs and, if this condition
persists, axonal destruction may follow

Table 1 depicts the types of nerve injury and their corresponding anatomic and clinical features.

Differential Diagnosis
As with any medical disorder; the diagnosis begins with the history and physical examination.
Because the etiology of Cumulative Trauma Disorder (CTD) can be so varied, the history should
encompass both occupational and non-occupational factors. The date of onset, character, extent, duration
and frequency of symptoms, causation, effect on function, and social implications of the injury should be
ascertained as well.

The physical examination should emphasize soft tissue. This includes a complete assessment of
muscle strength, spasm or contracture, sensory intactness for pin prick and proprioception, range of motion
(ROM) with the determination of articular abnormality kinesiologic function and restriction, ligamentous
laxity and resilence, tendon and synovial palpitation, and vasomotor/sudomotor changes relating to skin
temperature, color; swelling, and sweating.

The examination should not be confined to the area of presenting complaint, since the pathology may
be referred from another location. An example would be subjective pain and numbness in the first three
digits of the hand secondary to first dorsal interosseous myofacial syndrome, radiocaipal ligamentous
strain, carpal tunnel syndrome, extensor carpi radialis, longus tendonitis, or C-6 radiculopathy.
 Sensory symptoms in the fingers innervated by the median nerve and proximal radiation of pain can be
caused by compression of the C-6 or C-7 nerve roots. However; the symptoms of cervical raiculopathy are
rarely bilateral, are not usually worse at night, and are sometimes precipitated by neck movements. Also,
the sensory symptoms and signs in a cervical radiculopathy are usually in the dorsal as well as palmar
aspects of the thumb (C6) or the third digits (C7); there is often weakness of the muscles of the arm and
forearm supplied by nerves other than the median, the tendon reflexes in the arm are often reduced. Nerve
conduction studies are normal, but EMG usually shows abnormalities in muscles innervated by C6 or C7.

Wasting of the hand muscles, particularly those of the thenar eminence, can be caused by compression
of the lower trunk of the brachial plexus by a plexus by a cervical rib or band- the true neurogenic thoracic
outlet syndrome. However, the sensory deficits are usually in the C8 and T1 dermatomes - the fourth and
fifth digits and the ulnar border of the hand and forearm. Nerve conduction and EMG studies usually
clearly distinguish other entrapment neuropathies form CTS.11, 12

Discussion
Depending on the reference cited, CTDs account for 30% to 47% of workplace injuries. Part of the
problem in classifying the exact percentage is that they are referenced by many different names. They have
been referred to as repetitive use injuries, overuse syndromes, repetitive strain syndromes, and
cerviobrachial injuries. Among the more commonly reported diagnosis are Cubital and Carpal Tunnel
Syndrome (CTS), radial nerve entrapment and lateral epicondylitis, DeQuervain’s disease and
tendosynovitis, and a variety of synovitis and myositis abnormalities.

CTD injuries are disorders of the soft tissue, which are caused, aggravated, or precipitate from repeated
mechanical stresses, exertions, and movements of the body. Both occupational and non-occupational
factors are thought to contribute to their development. Occupational factors include forceful, repeated
exertions, especially in combination with neutral arm and hand postures and static muscle loads. Other
occupational factors reported in the literature include the use of certain hand tools, awkward gloves,
machine pacing, vibration, and a cold work environment.

Identified non-occupational factors are extensive. Some are related to lifelong or temporary medical
conditions others are related to lifestyle. While there is a consensus that human mechanical predisposition
toward the development of CTDs exists, there is a growing perception that certain types of medical
conditions are more important than once thought. A large percentage of medical conditions relate in some
manner to abnormalities of tissue blood flow.

It is known that the sympathetic component of the autonomic nervous system innervates tissues of
mesodermal and ectoderma] origin. It travels in close association with small, unmyelinated C fiber. The
relationship of sympathetically mediated pain syndromes and how these factors impact on CTDs merits
further study.

It appears that the incidence of Carpal Tunnel Syndrome (CTS) continues to grow at such a rapid rate
due to the changing industrial environment, the demand for more repetitive tasks for the worker, increased
patient awareness of cumulative trauma disorders and changes in overall work ethics. The shear costs
involved with the work-time lost, decreased productivity, medical treatment, rehabilitation and
management of CTS has caused a significant amount of attention to be focused by employers, medical
treatment, rehabilitation and management of CTS has caused a significant amount of attention to be
focused by employers, medical professionals, and insurance companies to aggressively work towards
reducing CTS cases.
 The National Institute of Occupational Safety and Health estimates that CTS occurs in more than
25,000 workers per year, costing approximately $4,000 in benefits and rehabilitation per patient and if
surgical intervention is required, the costs rise to more than $20,000 per patient. These figures do not
include costs associated with undesired pharmacological side effects or surgical complications reported
later by the patient.

In conjunction with the patient’s intake examination, exploration of the individual daily experiences
should be made. Once CTS is determined in differential diagnosis, the treatment approach requires potent
analgesic measures along with a well-planned rehabilitation program. This can be accomplished by
surgical or electroceutical methods. Treatment methods or therapy regiments include the following:

1. Electroceutical treatment 2. B-Complex vitamin therapy

3. Rest from repetitive tasks 4. NSAID therapy program
5. Flexibility exercise program 6. Cold (ice) therapy
7. Application of splint (mild CTS) 8. Medical Microwave Resonance (MMR)

The electroceutical methods were evaluated for the most consistent clinical results and it was found
that “specific-parameter electroceutical treatment” produced consistently better patient results that any
other therapy or therapy regimen. Overall results indicate an asymptomatic patient response in 79% of the
patients with no appreciable incidence of reoccurrence at a 6-month follow-up.

Materials and Methods

To assist in creating an average CTS patient profile, 150 patients from different geographical areas
whose history and examination findings were consistent with carpal tunnel syndrome were studied
prospectively. After a 3 day treatment trial, 17 patients were dropped from the programmed study because
they refused to discontinue pain medication, could not guarantee future-treatment compliance
(transportation problems), or reported an already-attained asymptomatic status (mild CTS). Of the
remaining 133 patients entering the 30-day regimen, 78 were women and 55 were men with occupations
primarily in the motor vehicle industry, data processing business, general manufacturing industry and from
meat-packaging or food processing plants. Both hands were involved in 87 patients and all reported
moderate-to-severe pain, paresthesia or numbness in all digits or in the median nerve distribution. The
duration of symptoms ranged from 5 weeks to 10 years and most patients noted easy fatigability with fine
motor activities, such as writing or buttoning clothes. Thirty-six (36) patients (27%) had co-existing
cervical arthritis, diabetes mellitus, or hypothyroidism.

All patients underwent formal diagnostic testing of the median curve which included the asymptomatic
extremities of the unbilateral CTS patients. Abnormal values consisted of distal motor latencies of 4.3
msec or greater and distal sensory latencies of 3.6 msec or greater. Terminal motor latencies over carpal
tunnel were determined by stimulation of median nerve 3 cm proximal to the distal flexion crease of the
wrist. 8, 9
 After the initial trial, a detailed treatment program was administered to all patients.
Specific-parameter bioelectric treatment was applied via special 6-field CTS anatomical electrodes - 20
minutes daily for 5 consecutive days and then every other day for 3 weeks (14 total treatments). Dosage
was initially set at just sensory threshold and, later in the course of treatment, increased to just below motor
threshold - each patient was dosed individually but never to an uncomfortable level. A special
electroceutical medical device was supplied and programmed with specific treatment parameters provided
by the Clinical Electromedical Research Academy (CERA).13 These electroceutical treatment parameters
were specified for producing the following necessary physiological effects in the treatment of CTD/CTS:
diffusion of metabolic toxins, anti-inflammatory action, increased circulation for trophic improvement,
counter-irritation and neuropeptide release for potent analgesia.

Although NSAIDs were discontinued for this study, it was found that when NSAIDs were given in the
initial acute pain phase, they produced a favorable influence in most all patients provided the dosage was
reduced to approximately one-half of the standard prescribed dose. Normally-prescribed dosage appears to
negatively influence or reduce the electroceutical treatment activity-even though no unusual side effects
were noted.14

The one-half dosage drug interaction with simultaneous electroceutical treatment warrants further
investigation because there appears to be no loss in drug potency while reducing possible standard-dose
toxicity or side effects.

Results, Summary and Conclusion

At the end of the 30-day treatment program, 79% (105) of the patients reported substantial, acceptable
partial pain relief or total pain relief (asymptomatic) of CTD/CTS symptoms. In addition to pain relief,
other improvements were noted - these included; increased active movements of extremities, restored
sensory function of extremities, restored sensory function of affected extremities, restored sensory function
of affected extremities, improved sleep and overall improved health, mental status, and quality of life.
Twenty-eight (28) patients (21%) reported unacceptable pain relief and elected surgical intervention. Of
the 21% of the patients considered treatment failures, most were considered to have congenitally narrow
carpal tunnels and possibly predisposed to CTS. In these cases, surgery would probably be the only
definitive option.

Although surgical intervention is still considered the definitive treatment for compression/entrapment
neuropathies like CTS, our study and summarized data indicates that a electoceutical regimen of specific-
parameter bioelectric treatment is an extremely effective alternative for eliminating permanent CTS
disability.

Based upon our research and other numerous, well documented reports covering non-invasive
approaches to CTD/CTS, it is or opinion that more than 75% of all CTS surgeries could be avoided,
especially by administering approximately 15 treatments (most cases) of cost-effective, specific-parameter
electroceutical treatment.

Compared with the escalating costs associated with a surgical approach to CTS and the
subsequent rehabilitation time that is typically required, the electroceutical approach should be
considered in the first line approach to this condition.
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