Cairn Terrier Groomers:
To Your (Hand and Wrist) Health!
Hand and wrist pain and dysfunction:
Research reports concerning preventive care and
chiropractic management
Here is a listing of four research reports, citations and summaries, concerning the management of hand and wrist pain and dysfunction with primary and secondary medical and chiropractic care of the upper extremities and the cervical spine. This research was conducted 1993-2007 at Northwestern Health Sciences University in Bloomington, MN, USA. Hand and wrist symptoms are common to people, especially in cases in which smaller-sized hands are asked to do extraordinary, forceful and repetitive hand-intensive work. This is the type of work done by those who hand-strip harsh-coated terriers.
In addition to professional medical or chiropractic care, groomers of terriers are urged to consider such protective measures as: bathing and drying the terrier (using a harsh-coat protecting cleaning solution) before grooming, grooming chalk, and rubber fingertips. Increased friction between outer coat and fingers decreases the pinch force required. In addition, groomers can also avoid exposing hands and wrists to cold temperatures and forceful, awkward wrist movements while hand-stripping and in general. Finally, groomers are urged, every five to ten minutes, to stop their work and move their hand and wrists into positions (forward flexion, eg) that enhance the circulation of fluids in the hand and wrist. If persistent numbness and/or tingling occur, groomers need to keep their hands and wrists warm and the neutral position … and even take a day or two off!
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Davis PT, Hulbert JR, Kassak KM, Meyer JJ. Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trial. J Manip Physiol Ther 1998;21(5):317-26.
This randomized-assignment, clinical trial (RCT), recruited 91 working-age participants with diagnosed (nerve conduction studies) mild or moderate carpal tunnel syndrome (CTS), assigning 45 to chiropractic and 46 to primary medicine. Volunteers with severe CTS were referred to a neurologist for evaluation.
The chiropractic treatment involved manipulation of the hand, wrist, forearm, and cervical spine to ease the passage of the median nerve through its sheath at the wrist. The medical treatment involved non-steroidal anti-inflammatory drugs (NSAIDS). Each group had nocturnal wrist wraps to keep affected wrists in a neutral position.
Participants were given nine weeks of treatment (three, two, then one chiropractic treatment session per week or one medical interview per week). One-month follow-up evaluations (Nerve condition studies and self-reported pain and functional status) indicated that (1) while there was no significant difference in the benefit received by participants in either group, (2) patients in both treatment groups improved significantly. Further, ten-percent of the medical group experienced strong reaction to the NSAIDS and dropped out.
With no pain-decreasing drugs, chiropractic provided benefit similar to medical treatment to people suffering from mild to moderate CTS.
Davis PT, Hulbert JR. Carpal tunnel syndrome: conservative and non-conservative treatment. A chiropractic physician’s perspective. J Manip Physiol Ther 1998;21(5):356-62.
This review discusses then-current surgeries available to treat severe carpal tunnel syndrome, short-term and longer-term outcomes, benefits and complications. The article provides original medical drawings and a reference list. Not surprisingly, the authors and medical-surgical advisors recommend conservative medical and/or chiropractic care for all but severe cases. Severe CTS involves muscle atrophy and abnormal motor function and may require neurological referral. In addition, primary medicine (NSAIDs) and chiropractic can be offered as a co-management strategy, even pre- and post surgery.
Hulbert JR, Printon R, Osterbauer PJ, Davis PT, LaMaack R. Chiropractic treatment of hand and wrist pain in older people: systematic protocol development. Part 1: informant interviews. J Chirop Med 2005;4(3):144-51.
This exploratory report provides results of focus groups and telephone interviews of chiropractors regarding their experience treating older (60+) patients in general and older patients with conditions of the upper extremities in particular. Respondents reported that one in five of their patients, on average, was aged 60 or older, one in ten of these presented with wrist problems and one in three with shoulder problems. Among older patients, over half present with some co-morbidity: osteoarthritis, diabetes, joint disease, etc. The authors summarize respondents’ recommendations: complete health histories (especially a complete listing of medications and careful review for drug interaction), stretching, exercise, less-forceful manipulations, and home-based stretching and exercise. Finally, the focus of care often needs to be on long-term management, rather than discrete episodes of care and cure.
Hulbert JR, Osterbauer PJ, Davis PT, Printon R, Goessl C, Strom N. Chiropractic treatment of hand and wrist pain in older people: systematic protocol development. Part 2: cohort natural history-treatment trial. J Chirop Med 2007;6:32-41.
This single-group, five-week pre-treatment surveillance and five-week treatment design, involving 47 participants, has served as a pilot project, gathering data that would support larger experimental designs. Preliminary self-reported outcomes indicate that chiropractic treatment of older (60+) for generalized hand and wrist pain and dysfunction (mirroring primary practice) offers significant benefit. Pre-treatment symptomatic pain and dysfunction was found to be stable, and post-treatment, six-month follow-up pain and dysfunction significantly improved. Treatment involved (following findings in Part 1 of the research) gentle manipulation of the hand, wrist, forearm, and cervical spine, passive stretching, and home-based exercise and stretching.
