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  • Gilbert Siu , J. Douglas Jaffe , Maryum Rafique and Michael M. Weinik
Published/Copyright: June 1, 2012
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 112 Issue 6

We appreciate Dr Sucher's excellent comments and clarifications regarding our review article on using osteopathic manipulative medicine (OMM) for treating patients with carpal tunnel syndrome (CTS).1 Dr Sucher's CTS research in this area was pioneering for the osteopathic medical profession and led us to review the current literature, including his research.

Dr Sucher rightfully notes that Figure 2 in our article1 is oversimplified. We illustrated the cross-section of the carpal tunnel for the purpose of demonstrating the close proximity of carpal tunnel structures. We had no intention of misleading the readers.

We also agree with Dr Sucher on the importance of musculoskeletal ultrasonography (US) in diagnosing CTS, with its benefits of noninvasiveness and short examination times being demonstrated within the past decade. Musculoskeletal US has shown its effectiveness in confirming and excluding cases of CTS, as well as in demonstrating anatomic lesions. However, a recent meta-analysis demonstrated the diagnostic sensitivity and specificity of musculoskeletal US for CTS to be 78% and 87%, respectively, while the sensitivity and specificity of electrodiagnostic studies are 85% and 95%, respectively.2,3 In comparison to electrodiagnostic studies, musculoskeletal US cannot grade the severity of CTS, which can lead to consideration of invasive or more aggressive treatment options, such as surgical intervention.4,5 Furthermore, this approach can result in a “higher cost,” because if musculoskeletal US is used as a first-line diagnostic tool, electrodiagnostic studies will most likely need to be conducted for confirmation and classification of CTS severity.

We thank Dr Sucher for his correction and description of the Opponens roll maneuver. Interestingly, our own studies have shown that an individual with CTS can self-administer the Opponens roll maneuver with improvement of CTS symptoms (unpublished data).

With the increasing incidence of CTS, further research is warranted in investigating the use of OMM for patients with CTS.6 We agree with Dr Sucher that research in musculoskeletal US will play an important future role in the application of OMM for such patients.

References

1 Siu G Jaffe JD Rafique M Weinik MM . Osteopathic manipulative medicine for carpal tunnel syndrome [review]. J Am Osteopath Assoc. 2012;112(3):127-139. http://www.jaoa.org/content/112/3/127.full. Accessed April 30, 2012.Search in Google Scholar

2 Robinson LR . Electrodiagnosis of carpal tunnel syndrome [review]. Phys Med Rehabil Clin N Am. 2007;18(4):733-746.10.1016/j.pmr.2007.07.008Search in Google Scholar PubMed

3 Fowler JR Gaughan JP Ilyas AM . The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis[published online ahead of print October 21, 2010]. Clin Orthop Relat Res. 2011;469(4):1089-1094.10.1007/s11999-010-1637-5Search in Google Scholar PubMed PubMed Central

4 Mohammadi A Afshar A Etemadi A Masoudi S Baghizadeh A . Diagnostic value of cross-sectional area of median nerve in grading severity of carpal tunnel syndrome. Arch Iran Med. 2010;13(6):516-521.Search in Google Scholar

5 Moran L Perez M Esteban A Bellon J Arranz B del Cerro M . Sonographic measurement of cross-sectional area of the median nerve in the diagnosis of carpal tunnel syndrome: correlation with nerve conduction studies. J Clin Ultrasound. 2009;37(3):125-131.10.1002/jcu.20551Search in Google Scholar PubMed

6 Gelfman R Melton LJ III Yawn BP Wollan PC Amadio PC Stevens JC . Long-term trends in carpal tunnel syndrome. Neurology. 2009;72(1):33-41.10.1212/01.wnl.0000338533.88960.b9Search in Google Scholar PubMed PubMed Central

Published Online: 2012-06-01
Published in Print: 2012-06-01

© 2012 The American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Articles in the same Issue

  1. AOA Communication
  2. Official Call
  3. Proposed Amendments to the AOA Constitution and Code of Ethics and New “Rules and Guidelines”
  4. Letters
  5. Environmental Reform Needed to Decrease Costs of Health Care
  6. Editorials
  7. Patient-Centered, Evidence-Based Decision Making
  8. Rigor in Medical Writing: Quoting Accurately
  9. Evidence-Based Clinical Review
  10. Patient-Centered Management of Atrial Fibrillation: Applying Evidence-Based Care to the Individual Patient
  11. Review
  12. Osteopathic Manipulative Treatment in Pregnant Women
  13. Medical Education
  14. Empathy in Osteopathic Medical Students: A Cross-Sectional Analysis
  15. Original Contribution
  16. Survey of Billing and Coding for Counterstrain Tender Points
  17. Special Communication
  18. Quoting A.T. Still With Rigor: An Historical and Academic Review
  19. Case Report
  20. Coexistence of Cushing Syndrome From Functional Adrenal Adenoma and Addison Disease From Immune-Mediated Adrenalitis
  21. Clinical Images
  22. Accidental Metallic Mercury Ingestion
  23. In Your Words
  24. Surfing Through the Night Shift in Brooklyn, New York
  25. Letters
  26. Osteopathic Manipulative Medicine for Carpal Tunnel Syndrome
  27. Response
  28. Correction
  29. Correction
  30. CME Quiz
  31. CME Quiz
https://doi.org/10.7556/jaoa.2012.112.6.384
Creative Commons
BY-NC-ND 4.0

Articles in the same Issue

  1. AOA Communication
  2. Official Call
  3. Proposed Amendments to the AOA Constitution and Code of Ethics and New “Rules and Guidelines”
  4. Letters
  5. Environmental Reform Needed to Decrease Costs of Health Care
  6. Editorials
  7. Patient-Centered, Evidence-Based Decision Making
  8. Rigor in Medical Writing: Quoting Accurately
  9. Evidence-Based Clinical Review
  10. Patient-Centered Management of Atrial Fibrillation: Applying Evidence-Based Care to the Individual Patient
  11. Review
  12. Osteopathic Manipulative Treatment in Pregnant Women
  13. Medical Education
  14. Empathy in Osteopathic Medical Students: A Cross-Sectional Analysis
  15. Original Contribution
  16. Survey of Billing and Coding for Counterstrain Tender Points
  17. Special Communication
  18. Quoting A.T. Still With Rigor: An Historical and Academic Review
  19. Case Report
  20. Coexistence of Cushing Syndrome From Functional Adrenal Adenoma and Addison Disease From Immune-Mediated Adrenalitis
  21. Clinical Images
  22. Accidental Metallic Mercury Ingestion
  23. In Your Words
  24. Surfing Through the Night Shift in Brooklyn, New York
  25. Letters
  26. Osteopathic Manipulative Medicine for Carpal Tunnel Syndrome
  27. Response
  28. Correction
  29. Correction
  30. CME Quiz
  31. CME Quiz
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