The book is intended mainly for the patient diagnosed with carpal tunnel syndrome (CTS) but some chapters are written specifically for health care providers. However as to its main purpose, the authors suggest that patients should use it as a teaching tool for their chiropractor, physical therapist, or massage therapist. The DVD is more clearly intended for health care professionals involved in the care of patients diagnosed with CTS.
The main premise of both the book and the DVD is that frequently CTS is not a local problem but rather that it is due to neurovascular compression in the thoracic outlet leading to both venous congestion in the arm including the carpal tunnel and a multiple crush syndrome masquerading as or predisposing to CTS. The book starts with patient testimonials followed by 8 chapters and 11 appendices. The chapters provide a discussion of the epidemiology, proposed pathophysiology, and current treatment for CTS and then contrast this to the authors’ view on etiology, differential diagnosis, and management. The authors’ own clinical research is presented in a separate chapter in support of the proposed approach. The appendices discuss relevant ergonomic considerations, stress reduction, and nutritional strategies and also provide the authors’ hand examination protocol and home exercise program. Two appendices extend the treatment principles discussed for CTS to neck pain, headache, and leg pain. The DVD has three sections: after an introductory section on proposed etiology, it provides information on a simple differential diagnostic examination and then illustrates the suggested treatment program consisting of trigger point release, myofascial mobilization and massage, lymphatic drainage techniques, modalities, and thrust and non-thrust joint manipulation.
This book does not provide a comprehensive review of relevant literature nor does it address issues of reliability and validity of the tests and measures presented. The authors’ own study is an uncontrolled case series with non-validated outcome tools. Certainly the book but --to a lesser extent-- also the DVD do not provide sufficient information to replicate the diagnostic and management process proposed by the authors. The book serves its intended purpose as a patient education tool but, as with many texts with a mixed intended audience, is of limited value to health care providers. Despite these limitations, the authors are to be commended for a grassroots attempt at clinical research. The test for carpal instability and the suggested splint are innovative and the holistic approach suggested certainly interesting. In summary, this text and the DVD may be of interest to clinicians that frequently see patients with a diagnosis of CTS and who are interested in some additional, albeit not evidence-based, diagnostic and management techniques.