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Biomedical subjects

B M Sucher

Publications and source records attributed to B M Sucher.

12 recordsLinked to original sources
PubMed1998

Manipulative treatment of carpal tunnel syndrome: biomechanical and osteopathic intervention to increase the length of the transverse carpal ligament.

To quantify the amount of transverse carpal ligament (TCL) elongation in response to osteopathic manipulation or sustained load bearing (or both), a study involving seven cadaver limbs was conducted. Distances from the trapezium to the hamate (distance A) and from the scaphoid to the pisiform (distance B) were measured in five mounted cadaver limbs during and after the limbs bore the weight (2 newtons [N] to 4 N) for 2 several-hour periods. A several-hour period occurred between the weight bearing to assess recoil. Distances A and B were measured before and after the limbs were manipulated, according to previously described techniques, as well as with a new maneuver, termed the "guywire" technique. Two dissected limbs also were subjected to further weight bearing, this time increased to 8 N. Greater weight loads produced greater lengthening of the TCL, and recoil after removal of weight loads was slower than recoil after manipulation. Manipulation was more effective than weight loading for increasing distance A (distal canal), but weight loading generally was more effective than manipulation for increasing distance B (proximal canal). The guywire manipulation combined with direct transverse extension appeared to have the greatest impact on lengthening the TCL distally. These results show promise for the effective use of manipulation and load bearing for TCL elongation and nonsurgical relief of pressure on the median nerve in patients with carpal tunnel syndrome.

Biomechanical Phenomena↗
PubMed1995

Palpatory diagnosis and manipulative management of carpal tunnel syndrome: Part 2. 'Double crush' and thoracic outlet syndrome.

The physician treating carpal tunnel syndrome needs to be aware of the possible concomitant occurrence of thoracic outlet syndrome, the so-called double crush syndrome. Palpation is used to differentiate carpal tunnel syndrome from thoracic outlet syndrome. Such palpatory examination assists the physician in planning the initial treatment, including osteopathic manipulation and self-stretching maneuvers, targeted specifically at the most clinically significant pathologic region. Supplemental physical medicine modalities such as ultrasound may enhance the treatment response. Some illustrative cases are reported.

Adult↗
PubMed1994

Palpatory diagnosis and manipulative management of carpal tunnel syndrome.

Carpal tunnel syndrome was studied by use of supplemental palpatory diagnosis in 20 abnormal wrists. Restriction in motion at the carpal tunnel was quantified with a rating system. All wrists with carpal tunnel syndrome revealed at least moderate restriction to motion, as compared with only mild or no restriction in 20 wrists in normal, symptom-free subjects. Several participants (16 abnormal wrists) underwent osteopathic manipulative treatment, including a new "opponens roll" maneuver, and self-stretching, or a similar treatment accomplished by use of a self-treatment accomplished by use of a self-treatment appliance. In those treated, palpatory restriction decreased into the normal range, often before symptoms decreased. Improvement in nerve conduction studies usually followed within 1 to 3 months. Palpatory diagnosis is a useful adjunctive method of assessing patient status in carpal tunnel syndrome and helpful in prognosticating outcome. The modified manipulative technique described for the treatment of mild to moderate carpal tunnel syndrome may be effective in more severe cases.

Adult↗
PubMed1993

Myofascial manipulative release of carpal tunnel syndrome: documentation with magnetic resonance imaging.

Four patients with carpal tunnel syndrome, unresponsive to routine conservative care, underwent treatment with myofascial release manipulation and self-stretching. Magnetic resonance imaging analysis of the cross-sectional area of the carpal tunnel and electrodiagnosis were performed before and after treatment. The patients improved clinically. The nerve conduction studies showed concomitant reduction in distal latencies or increase in motor response amplitudes. Magnetic resonance imaging demonstrated that the anteroposterior and transverse dimensions of the carpal canal significantly increased after treatment. This study demonstrates that the carpal canal is a distensible structure with the potential to yield to a relatively simple, aggressive, nonsurgical treatment for carpal tunnel syndrome.

Aged↗
PubMed1993

Myofascial release of carpal tunnel syndrome.

Current treatment for carpal tunnel syndrome may be ineffective or associated with complications or recurrence. In the case reported here, a myofascial release by the physician combined with the patient's self-stretch reduced pain and numbness and improved electromyographic results. The manipulative approach releases the transverse carpal ligament,-and "opens" or dilates the canal. The patient stretches the wrist, digits, and thumb, including myofascial components. An aggressive, conservative approach lessens the need for surgery in mild to moderate cases. Studies with magnetic resonance imaging may be helpful to document canal size before and after treatment.

Carpal Tunnel Syndrome↗
PubMed1993

Thoracic outlet syndrome--a myofascial variant: Part 3. Structural and postural considerations.

Thoracic outlet syndrome involves more than just local neurovascular compression. Myofascial release treatments and stretching exercises may be only partially or temporarily successful unless all related components of somatic dysfunction, including craniosacral mechanisms, are addressed. Structural and postural abnormalities in the frontal plane, as with a short leg, and in the sagittal plane, such as lumbopelvic imbalances, as well as neural involvement all contribute to thoracic outlet syndrome symptoms. Once segmental restrictions are treated and symptoms diminish, postural correction and strengthening exercises may be initiated. Osteopathic diagnosis and treatment of the local, regional, and remote structural problems is necessary for optimal treatment of thoracic outlet syndrome and the maintenance of a symptom-free status.

Humans↗
PubMed1990

Thoracic outlet syndrome--a myofascial variant: Part 1. Pathology and diagnosis.

Four cases of thoracic outlet syndrome are described, with observations to support a primary myofascial etiology involving the scalene and smaller pectoral muscles. It is believed that thermography can be extremely helpful as an aid in diagnosis of thoracic outlet syndrome and, when combined with Doppler blood flow studies and photoplethysmography, can help localize the site of the pathosis. Thermography is a sensitive, non-invasive test that most clearly demonstrates pathology in the hand views. Global changes throughout the entire hand suggest vascular or reflex autonomic involvement, while a more dermatomal distribution suggests specific neurologic involvement. Vigorous stretching and a unique form of myofascial release manipulation has been successful in rapidly treating patients with thoracic outlet syndrome. Follow-up thermography (perhaps hand and forearm views only) can be used to monitor response to treatment and to objectively document improvement.

Adult↗
PubMed1990

Thoracic outlet syndrome--a myofascial variant: Part 2. Treatment.

Thoracic outlet syndrome (TOS) may be treated successfully with a powerful form of myofascial release manipulation and stretching. Self-stretching exercises complement all other treatment modalities for TOS. Maximal effect is achieved with high-frequency, progressive stretching, tapered rapidly to a maintenance level as symptoms diminish. Stretching must be demonstrated "hands on" with the patient and reviewed and modified regularly. The techniques are similar to those of Travell and Simons, with modifications. The pain of TOS is intimately connected with short, contracted muscles that develop trigger points. An engram for the shortened muscles develops centrally. The myofascial release technique involves local release of myofascial structures, re-energizing of the tissues, and reprogramming of the central engram for the particular muscle length.

Exercise Therapy↗
PubMed1982

Guillain-Barré syndrome with secondary bilateral posterior interosseous nerve syndrome.

A case of Guillain-Barre syndrome (GBS), with secondary entrapment of the posterior interosseous nerve bilaterally, is presented. It is felt that this was caused by the edema associated with the primary GBS, which led to compression with an anatomically narrowed supinator space, previously aggravated by repetitive pronation-supination. Diagnosis of such cases demands careful serial physical examinations, electromyography, and nerve conduction velocity studies. Appropriate splinting and careful exercise to balance muscle return are essential in physiatric management.

Adult↗