Volume 94, Issue 8

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 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.

The scandalous disparity between the health indicators for minority and nonminority and poor and nonpoor populations is of such long standing that it has lost the power to shock. The authors review the landmark studies of the past year which document discrimination in the healthcare system. They reiterate the most compelling statistics of mortality, birth, the AIDS epidemic, destructive health habits, and poverty. They trace the impact of health care policy on these vulnerable populations and address the myth that malpractice claims are filed more frequently by the poor. They conclude that equality is instrumental to the improvement of the nation's health demographics; the persistence of economic, social, and political discrimination will continue to create barriers even if financial access is assured through a pluralistic approach to healthcare reform. Ultimately, they predict that any healthcare reform that does not address minority issues is doomed to fail if all three areas driving the national "crisis"access, cost, and quality---do not encompass minority-specific healthcare strategies.