Volume 98, Issue 12

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 “guy-wire” 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 guy-wire 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.

The neonate is unable to relate specific complaints of pain and may not exhibit the usual signs of illness or infection. Septic arthritis of the hip is a surgical emergency in the neonate, and it should be considered in any irritable or ill child who has a high index of suspicion. Prompt diagnosis and immediate treatment are necessary. Nearly all babies undergo routine examination of the hip for dysplasia. It is recognized that limitation of abduction of the hip in the neonate may not represent developmental dysplasia of the hip but may represent other etiologies, such as fracture, infection, congenital anomaly, or tumor. The following case report illustrates the importance of careful clinical evaluation of an apparent asymptomatic neonate.

An unusual presentation of thyrotoxicosis resulting in hypokalemic periodic paralysis is reported here. The patients with this disorder have very low serum potassium levels during the active phase of the disease. Very often, several months pass before the diagnosis is made. Once recognized and the thyrotoxicosis is treated, the patient does well.

This commemorative note, in recognition of the 100th anniversary of radiology in osteopathic healthcare, reviews the development of the specialty from the initial availability of primitive equipment to its present status as an important component of patient care and a significant element in the consideration of socioeconomic issues affecting patient welfare. The osteopathic medical profession was quick to grasp the potential of the new modality, and its history is an exciting aspect of osteopathic medicine’s progress.