Carpal tunnel syndrome (CTS) is the most expensive of all work-related injuries and can affect anyone. CTS has become the most significant medical problem affecting workers at the turn of the century, accounting for nearly 60% of work related injuries. Over his or her lifetime, a carpal tunnel patient loses about $30,000 in medical bills and time absent from work. CTS can be painful and debilitating, but early carpal tunnel treatment can lead to a quicker recovery.
CTS typically occurs in adults, with women aged between 40 and 55 years old being 3 times more likely to develop it than men. Sometimes young women get carpal tunnel symptoms while pregnant. The dominant hand is usually affected first, and the pain is typically severe. CTS is especially common in assembly-line workers in manufacturing, sewing, finishing, cleaning, meatpacking, and similar industries. Also, people who perform repetitive motions with the hands such as typists, checkout staff, hairdressers, weightlifters, carpenters and mechanics, and those operating machinery producing vibration may also be affected. Contrary to the conventional wisdom, according to recent research, people who perform data entry at a computer (up to 7 hours a day) are not at increased risk of developing CTS.
What Is CTS?
Carpal tunnel syndrome (CTS, or wrist repetitive strain injury, RSI) is the disability that results when the median nerve in the arm is pinched or inflamed in the carpal tunnel. The median nerve has its roots exiting between some of the vertebrae in the lower neck region from the brachial plexus, and then running down the arm thru a narrow tunnel, the carpal tunnel, at the wrist above the palm and then into the fingers of the hand. The median nerve is the only nerve that passes through the carpal tunnel.
The carpal tunnel consists of a thick, fibrous band of tissue found on the front side of the wrist at the base of your palm in the same area as your watch strap. It holds many of the bones, tendons, ligaments, nerves and blood vessels that are required to operate your hand. CTS can occur if the carpal tunnel is damaged and median nerve pressure/compression is placed on the vulnerable nerves and arteries. This can be the result of sustained activities like typing, hammering, or pushing. Many believe that constant repetitive use of the hand of the same type over an extended length of time causes the problem. For example, anyone working at a computer all day is at a higher risk due to the continual strain placed on the muscles of the shoulders, forearms, wrists and hands.
Usually CTS begins slowly over weeks to months, with symptoms worsening over time. CTS may include pain in the hand or wrist that occurs mostly at night that can radiate up into the forearm, hand numbness, weakness or clumsiness of the hand, loss of hand grip strength and muscle loss in the palm of the hand. An injury such as a broken wrist or a dislocated hand bone harms the nerve as well. In some cases the carpal tunnel is smaller in some peoples’ hands and therefore leads to a higher likelihood of CTS occurring. Even though numbness feels like it occurs in the entire hand, normally it is only in the thumb, index, and middle fingers. CTS is the most common of the “entrapment neuropathies”—compression or trauma of the body’s nerves in the hands or feet.
What Are the Symptoms?
As stated previously, burning, tingling, itching, and/or numbness in the palm of the hand and thumb, index, and middle fingers are most common. Some people with CTS say that their fingers feel useless and swollen, even though little or no swelling is apparent. Since many people sleep with flexed wrists, the symptoms often first appear while sleeping. As symptoms worsen, they may feel tingling during the day. In addition, weakened grip strength may make it difficult to form a fist or grasp small objects. Some people develop wasting of the muscles at the base of the thumb. Some are unable to distinguish hot from cold by touch.
Why Does CTS Develop?
Some people have smaller carpal tunnels than others, which makes the median nerve compression more likely. In others, CTS can develop because of an injury to the wrist that causes swelling, over-activity of the pituitary gland, hypothyroidism, diabetes, inflammatory arthritis, mechanical problems in the wrist joint, poor work ergonomics, repeated use of vibrating hand tools and fluid retention during pregnancy or menopause.
How Is It Diagnosed?
The earlier that a repetitive strain injury such as CTS is diagnosed and treated, the better the outcome.
Following a detailed consultation, a standard physical examination of the neck, shoulder, arm, elbow, wrist and hands will be undertaken. A determination will be made if your symptoms are related to daily activities or to an underlying disorder which may also start in the neck, shoulder or elbow regions too.
Your doctor of chiropractic can use other specific tests to try to produce the symptoms of carpal tunnel syndrome. The most common are:
- Pressure-provocative test. A cuff placed at the front of the carpal tunnel is inflated, followed by direct pressure on the median nerve.
- Carpal compression test. Moderate pressure is applied with both thumbs directly on the carpal tunnel and underlying median nerve at the transverse carpal ligament. The test is relatively new.
Also, medically ordered laboratory tests and x-rays can reveal diabetes, arthritis, fractures and other common causes of wrist and hand pain. Sometimes electro-diagnostic tests, such as nerve conduction velocity testing (EMG), are used to help confirm the diagnosis. With these tests, small electrodes placed on your skin, measure the speed at which electrical impulses travel across your wrist. CTS will slow the speed of the impulses and will point your doctor of chiropractic to this diagnosis.
Misdiagnosis of CTS may often occur because the sensitive nerves and arteries that pass through the carpal tunnel can be affected elsewhere, resulting in similar symptoms. For example tight neck or arm muscles can irritate the nerves passing through them leaving the person with symptoms that do not go away with treatment of the carpal tunnel. That is why your chiropractor will assess the neck, shoulder and elbow on the affected side(s). Carpal tunnel syndrome may also be aggravated by diseases such as diabetes, rheumatoid arthritis or thyroid problems, but CTS is usually due to physical/mechanical repetitive strain injuries.
What Is the CTS Treatment?
Chiropractic adjustments and spinal/joint manipulation has shown to be the most conservative effective method of approach to carpal tunnel treatment because chiropractors are experts in the musculo-skeletal system, joints and the nervous system. A spinal adjustment involves applying controlled pressure to a joint. Misalignment in the spine does contribute to symptoms of carpal tunnel syndrome.
At his office, Dr. Pisarek will perform generally painless, specific chiropractic spinal and/or joint adjustments and mobilizations that aim to correct improper alignment which also helps the joints in the wrist and hand to move freely. Dr. Pisarek typically performs these adjustments using his hands, but sometimes other devices and techniques are employed. Everyone’s case is different.
Other treatment options offered by chiropractors include: soft tissue treatments which release muscle tension and remove adhesions which may be impinging on the nerves, low-level laser therapy (LLLT), physiotherapy, targeted stretches and strengthening exercises specifically designed to minimize muscle strain and improve small muscle strength, yoga, nutritional advice, splinting/bracing and suggestions on modifying the work environment to prevent over use. Scientists are also investigating other therapies such as acupuncture that may help prevent and treat this disorder.
Initial therapy includes:
- Resting the affected hand and wrist
- Avoiding activities that may worsen symptoms
- Immobilizing the wrist in a splint to avoid further damage from twisting or bending
- Applying cool packs to help reduce swelling from inflammations
- Medicinally, some readily available over-the-counter (OTC) medications can help with pain control and inflammation.
- Studies have shown that vitamin B6 supplements may relieve CTS symptoms. Click here for further information on B6 micronutrient supplementation published in the "CFP: Canada Family Physician - Official Publication of the College of Physicians of Canada".
Medical treatment includes diuretics, sedatives and non-steroidal anti-inflammatory drugs (NSAIDs) to provide temporary relief. When these fail, a physician may resort to corticosteroid injections which sometimes temporarily relieves pain or swelling, but does not necessarily treat the problem. Surgery to decompress the median nerve is often resorted to in extreme cases with patients whose symptoms fail to respond to conservative care. The majority of patients recover completely after surgical treatment, and the recurrence rate is low. However, surgery has its own complications including possible recurrence or worsening of the condition due to a rare scaring of the carpal transverse ligament and may result in it becoming weakened and ultimately symptoms will reoccur. Therefore, surgery should be used as a tool when all other treatment has been unsuccessful.
Be sure to consult your chiropractor prior to surgery, as it should be your last resort. Regardless of the treatment, full recovery will only come about by avoiding stressful situations and changing work habits.
How Can CTS Be Prevented?
Repetitive strain injuries (RSI) can often be prevented with proper workplace ergonomics and by taking frequent breaks to stretch and change position. Your chiropractor can advise you what are the best stretches and strengthening exercises to help prevent repetitive strain injuries from your specific job or profession. Proper posture and movement as instructed by your doctor of chiropractic can help prevent CTS recurrences too.
The American Chiropractic Association recommends the following tips:
- Perform on-the-job conditioning, such as stretching and light exercises.
- Take frequent rest breaks.
- Apply cold to reduce inflammation.
- Periodically stretch and massage your forearm muscles.
- Periodically stretch your chest muscles.
- Wear splints or braces to help immobilize the area.
- Keep your wrists straight.
- Use fingerless gloves to help keep the hands warm and flexible.
- Use correct posture and wrist position.
- To minimize workplace injuries, jobs can be rotated amongst workers, Employers can also develop programs in ergonomics---the process of adapting the workplace to the employee.
- Adopt correct sitting posture.
- Ensure correct work station arrangement.
- Avoid prolonged or repetitive wrist and finger flexion or extension.
- Avoid prolonged or repetitive grasping.
- Use a wrist support pad (keyboard support and mouse-pads).
Please Note: The information provided here is merely for information, referential and not for commercial gain. It is in no way a representation of professional medical advice and you should consult your chiropractor to determine any possible diagnosis and carpal tunnel treatment methods you may require.
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