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Carpal Tunnel Syndrome

May 16, 2011

Carpal tunnel syndrome.  The term gets thrown around a lot not just here in Guelph, but all over.  It conjures up images of wrist braces, sore hands and forearms, and specially padded keyboards.  But what is typically assumed to be carpal tunnel syndrome often isn’t.  Why should that make a difference?  Read on…

Carpal tunnel syndrome (CTS) is a nerve disorder within the wrist characterized by pain, weakness, tingling, and loss of sensation of the hand and fingers.  CTS occurs when the median nerve is trapped and pinched within the carpal tunnel of the wrist.  The carpal tunnel itself is a space found on the palmar side of the wrist and is bordered by the carpal bones and transverse carpal ligament (there may be a test at the end*).

Overuse of the wrist can lead to swelling and inflammation within the carpal tunnel which, in turn, causes irritation and compression of the median nerve passing through.  Some predisposing factors include:

Work requiring repetitive wrist/hand motion

Use of vibrational equipment/machinery

More common in women (especially when pregnant)

Not to get too bogged down in the details, but there is a bit more to consider.  The median nerve has a branch that splits off just before it passes through the carpal tunnel.  It is this palmar branch of the median nerve which supplies sensation to the middle of the palm.  With true carpal tunnel syndrome you may notice wrist pain with accompanying finger numbness, but you typically will still have normal sensation in the palm of the hand because that branch of the median nerve is spared compression.  Identifying this difference through a thorough history and physical examination by a chiropractor or other therapist is important – it can mean the difference between conservative treatment,  possible electrodiagnostic testing, or potential surgery.

I started off this post, however, implying that the term CTS is often misused because pain, weakness, and altered sensation of the hand and wrist can be caused by structures other than the carpal tunnel.  For instance, the median nerve, which travels the distance between the neck and the fingers can become compressed and irritated anywhere along its’ path.  Tight muscles of the forearm are often the most likely culprits.  Other conditions such as golfer’s elbow, tennis elbow, and pronator teres syndrome may be confused with CTS.  It is important to have a thorough evaluation of your specific complaint in order to direct which treatments are best.  From a chiropractic perspective we make sure to evaluate along the entire mechanical chain to see if there are other factors in the elbow, shoulder, or neck which may be contributing to the condition.  And when CTS is still high on the list of differential diagnoses,  managing the symptoms with a conservative treatment plan is the best place to start.  However, if not improving, the definitive evaluation  for CTS is electrodiagnostic testing of the nerves which I believe is very important prior to exploring any surgical options.

Most health care practitioners will agree that conservative management is the first step for forearm, wrist, and elbow complaints .  Treatments can include:

Rest and ice to avoiding aggravating factors and reduce inflammation

Stretching tightened muscles of wrist and forearm.  Very simple: reach your arm out in front with palm up. Use other hand to gently pull fingers down toward floor.  Hold 20 seconds.  Repeat several times throughout the day.

Muscle release therapy

Modalities such as microcurrent and TENS

Wrist splinting either for work or in bed to reduce repetitive straining movements or positions

Ergonomic changes made to workspace environments such as proper positioning of mouse, keyboard.

If you suspect you have carpal tunnel syndrome or suffer from other hand, wrist and forearm pain, see your chiropractor at Clear Path Chiropractic Health Centre in downtown Guelph Ontario.

*Okay, so there’s no test.  But I’d like to hear about any experiences you’ve had with CTS or other similar conditions. What’s worked well for you?  Were you able to manage it on your own, or did you require some extra intervention?

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