Paul Manley Back Pain and RSI Clinic

Paul Manley, D.O. (ESO 1980), M.A.O.(Manip), Registered Osteomyologist

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Paul Manley, D.O. (ESO 1980), M.A.O.(Manip),
Registered Osteomyologist, RSM
(Royal Society of Medicine)
Specialist in the treatment of Musculo-skeletal problems

Location: 33 Chalton St, London NW1 1JD (Close to Kings Cross and Euston stations)

Get help right now for your musculo-skeletal pain - Phone or text 24/7: 07925 616 753

Do you have Carpal Tunnel Syndrome ?

Most often this condition is mis-understood, mis-diagnosed and mis-treated.

A genuine Carpal Tunnel Syndrome in my opinion exhibits wasting of the thumb muscles and pins and needles and numbness in the thumb, index, middle and tip of the ring fingers. There is often pulsating pain in the hand and great weakness of the grip.

 The example below is an extreme case.
The main cause is thought to be compression of the Median nerve where it enters the wrist.

Operations are performed on the palm area to try to free the nerve from compression.
The operation is usually effective so long as the cause is properly indentified.

Despite the effectiveness of the operation the problem can often re-occur due to the long term scarring and fibrosis.

You're more at risk of CTS type symptoms if you:

are overweight
are pregnant
suffer from hypothyroid (low thyroxine)
some types of collagen disease (rare)
do work or hobbies that mean you repeatedly bend your wrist or grip hard, such as using vibrating tools (Vibration white finger (VWF) is a long-term condition that can result from prolonged use of vibrating tools, either for occupational or recreational use. VWF causes numbness or tingling in the fingers, which is often accompanied by whitening (or blanching) of the fingertips
have repeatedly hit your palm e.g. hitting a chisel or pressing on a screwdriver, pushing a carving tool without sufficient padding on your palm (beat hand)
have previously injured your wrist or fractured your radius, ulna, carpal bones or metacarpal bones
have a degenerative or bulging disc in your neck
thoracic outlet syndrome. This syndrome has many causes including lung tumours, cervical rib, raised first rib and muscle spasm or inflammation in the lower neck or shoulder muscles
leaning of the inside of the arm (median nerve) and or leaning on the inside of your elbow (ulnar nerve)

It can be confused with Raynauds disease and reflex sympathetic disorders. The fingertips over-react to cold, turn pale and painful. In diabetes (severe) the fingers and toes can go numb.

Symptoms are often worse on waking and partially or wholly relieved by movement.

What is Cubital Tunnel Syndrome ?

It is often assumed to be due to narrowing of the cubitaltunnel of the elbow.This condition produces symptoms in the Ulnar nerve supply to the palm.
It can be produced by leaning on the outside of the wrist for example when using a mouse
It can be produced by leaning on the inside of the elbow e.g. on an arm rest
It is also caused by neck tension and distortions in the upper ribcage
If the neck vertebrae are degenerated or simply in spasm it can affect both Ulnar and Median nerves
Hypertonus of the forearm muscle which flexes the little and ring fingers can also be a factor


You can have a nerve conduction test and MRI in order to pinpoint the compression. These are not very conclusive in milder cases.
This is where we come into conflict with the other causes of the same symptoms.

Testing the reflexes of the arm can reveal whether a disk in the neck is pinching a nerve root or whether the cause is further down the arm. When the thumb muscles are too hypertonic they will produce numbness and pains and needles in the thumb and index finger.

The main symptoms are pins and needles and numbness in the Median nerve supply to the fingers.
Unfortunately for the diagnostician there are a few other areas where such compression commonly occurs. Most of us have experienced transient pins and needles and numbness which fades after a few seconds. A 'dead leg' is a good example. Often we can wake up with numbness in the hand which disappears after we start to move around. However when these symptoms persist over hours and days it indicates a more severe compression.

If you look at the illustration below you can see the various places of compression.
All too frequently we go to the doctor with these symptoms but the doctor is not familiar with the other points of compression or what to do about them.

I recently had a patient from New York who had operations to 'free up' the cubital tunnel on both arms when in fact he was exhibiting signs and symptoms of Median nerve compression! This expensive surgery was pointless and did nothing for his symptoms. The problem lay in the hypertonus of the wrist deep flexors and deep biceps coupled with compression in the neck vertebrae and muscles.

So what can you do about avoiding surgery?

Try an Osteopath or a massage person familiar with direct treatment to the forearm and hand. Preferably with some considerable experience in manipulation or articulation of the wrist joints.
They should also be capable of differentiating between what is possible and what is not. Many such practitioners assume it is all coming from the neck especially Chiropractors. Physiotherapists are generally limited to giving exercises that can be useless in the absence of 'hands on' treatment. Such expertise can be difficult to find.

I have had to learn and develop many specialised techniques following my basic training (four years). Luckily I was presented with many such cases whilst still a student and working in my Fathers practice. He had many music students who consulted him. Dad didn't have the skills to help so he 'gave' them to me with the advice that I would just have to figure it out. So I did and to great success.

The techniques in the movie below show a few of the skills that I have gained during my 40 year career. Perhaps if you show these to your practitioner they may be able to use them.

If you can get to see me, give me a call and I will assess and treat your disabling syndromes before they potentially become worse.

Please Call or Text Paul 24/7 on 07925 616 753
London location: 33 Chalton St, London NW1 1JD (Close to Kings Cross and Euston stations)