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Treatment Option Comparison for Carpal Tunnel Syndrome

7 Dec

Carpal tunnel syndrome (CTS) results from the compression of the median nerve as it travels through the wrist. Classic symptoms associated with CTS include numbness, tingling, and weakness in the thumb, index, middle, and ring finger. In non-emergency situations, treatment guidelines recommend patients undergo conservative care before considering more invasive procedures, like surgery. This month’s article will look at the differences between standard medical care vs. chiropractic care to treat CTS.

In a case study series, researchers divided 91 patients with confirmed signs and symptoms of CTS into two groups: one receiving standard medical care utilizing ibuprofen and night splints; and one group receiving chiropractic care including manipulation of the upper extremity bony joints and soft tissues, as well as spinal manipulation. Researchers monitored improvement with self-reports, nerve conduction, and vibrometric sensation testing of the affected hand.

Both treatment groups experienced improvements in comfort, finger sensation, and nerve conduction; however, vibrometric sensation testing revealed greater improvements among members of the chiropractic treatment group (3.05 decibels vs. 1.37 decibels).

The authors of the study point out that chiropractic provides an alternative form of non-surgical care, and patients with CTS should be offered the option, especially for those who cannot take a non-steroidal anti-inflammatory drug (NSAID) due to intolerance like stomach irritation or liver-kidney issues. Personal preference is also important in the decision making process for CTS.

Other CTS treatment options often offered by doctors of chiropractic include work modifications, ice therapy, and nutritional options such as ginger, turmeric, boswellia, bromelain, fish oil, and others. There are also CTS-specific stretching exercises that can be done multiple times per day at home and work. The treatment plan for the CTS patient will often include several of these options in order to achieve a satisfying outcome.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.
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What Causes Carpal Tunnel Syndrome?

6 Nov

Carpal tunnel syndrome (CTS) is a condition that arises when the median nerve becomes compressed as it travels through the bony tunnel made up of the eight small carpal bones of the wrist. Its symptoms include pain, numbness, and tingling in the thumb, index, middle, and thumb-side half of the ring finger. If the pressure is great enough, weakness in grip and pinch strength can occur as well.

There are many conditions or factors that contribute to and/or cause CTS, which can complicate its diagnosis and treatment. Some of these include: diabetes, obesity, pregnancy, birth control pills, hypothyroid (low thyroid function), arthritis, smoking, alcohol abuse, poor nutrition, being female (due to wrist size and/or hormonal shifts), bony abnormalities (such as spurs, misalignment of the carpal bones, and tunnel shape), aging, and certain occupations (heavy manual labor, vibrating tools, high repetitive tasks, firm gripping requirements, food servers, dental hygienists).

Additionally, impingement of the median nerve as it passes through other structures in the body can contribute to a patient’s symptoms, so it’s important for a doctor of chiropractic to examine the entire course of the nerve—from the neck to the shoulder to the elbow and then to the wrist. In some cases, the median nerve may not be impeded as it passes through the carpal tunnel but rather, there is pressure on the nerve elsewhere that causes symptoms similar to CTS. In these instances, if treatment only focused on the wrist, the patient may not have a successful outcome.

Outside of an urgent condition, like a broken wrist that may require surgery to take the pressure off the median nerve, treatment guidelines recommend using conservative (non-surgical) approaches first. This can include addressing any activities that place pressure on the nerve (making changes to a workstation, for example) or conditions that may contribute to inflammation or swelling in the wrist.

Inflammation within the carpal tunnel can be reduced using both ice therapy, as well as by consuming turmeric, ginger, and other spices with anti-inflammatory properties.

To restore normal motion to the joints in which the median nerve may be compressed, doctors of chiropractic may utilize manual therapies such as manipulation and mobilization. Patients may also wear a wrist splint at night in order to avoid increased pressure caused by bending the wrist in an effort to find a comfortable sleeping position.

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Carpal Tunnel Syndrome and Body Type

5 Oct

Is there a relationship between carpal tunnel syndrome (CTS) and body mass index (BMI)? A 1994 study focused on 949 patients who presented with right arm numbness and tingling. In the study, the patients underwent electromyography and nerve conduction velocity (EMG/NCV)—the “gold standard” of tests to diagnose nerve injuries in conditions such as CTS.

Researchers then sub-divided the group by age (three groups: younger than 45; between 45 and 64; and 65 or older), body size (defined by BMI), and gender. Investigators compared those who were obese (BMI more than 29) to the other groups: slender – BMI less than 20; normal – BMI 20-The findings revealed that of the 261 patients diagnosed with CTS, only 16% were slender compared with 39% who were obese. This indicates that those with obese body types are 2.5 times more likely to develop CTS than slender individuals. Regarding gender, 43% of obese women had CTS compared to 32% of obese males, and 21% of slender women had CTS compared to 0% of slender males. The mean age for the CTS patients was higher at 48.1 years of age (vs. 44.7 years), with the peak occurrences in the 45-65 year old group (41%), followed by those 65 years or older (26%), with the rate in those younger than 45 years old group at  21%.

This study is consistent with previously identified risk factors for developing CTS: obesity, older age, and being female. But are there additional “body type” risk factors?

It turns out that other studies have found that people with square-shaped wrists, short/wider palms (with shorter third fingers), and those with poor upper back strength all have a higher risk for developing CTS.

We’ve looked at other well-known risk factors previously such as diabetes, arthritis, pregnancy, birth control pill use, occupation type, smoking, alcohol abuse, poor nutrition, high LDLs (“bad” cholesterol), and genetic factors. Doctors of chiropractic are trained to diagnose and treat CTS, and ALL studies recommend EARLY treatment, so DON’T WAIT!

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Carpal Tunnel Syndrome Splints

7 Sep

Wrist splints are often a beneficial form of CTS self-care, as they can assist in relieving the pressure within the carpal tunnel by restricting wrist flexion and extension.  Because we cannot control the position of our wrist during sleep and the pressure on the nerve worsens the more it bends forwards or backward, splints are most commonly used during sleep.

There are literally hundreds of options of splints available online that range from simple glove-like splints (some with and without the fingers covered) to full arm splints. The majority block wrist motion and use Velcro closures with metal bars on the bottom and/or top of the splint. Your doctor of chiropractic can help you choose the best splint for your particular case.

There are studies that have attempted to isolate one form of treatment from others for conditions like CTS, but as noted in a 2012 Cochrane report, many of these studies involve small sample sizes, making it difficult to draw firm or hard conclusions. Moreover, healthcare providers typically utilize MANY approaches simultaneously to achieve the best, most prompt results, keeping surgery as the last resort.

Typically, the non-surgical management of carpal tunnel syndrome (CTS) includes several approaches such as splints; rest; job modifications; anti-inflammatory measures like ice, drugs, vitamins, and herbs; physical modalities, such as ultrasound and laser; and manual therapies, such as manipulation and mobilization.

Care may also focus on relieving pressure on the median nerve in other anatomical locations (the neck or shoulder, for example) as dysfunction elsewhere on the course of the nerve can contribute to a patient’s CTS symptoms. Furthermore, a treatment plan may also address other conditions that can contribute to the build-up of pressure in the carpal tunnel such as diabetes or hypothyroidism. Generally, it’s more challenging to manage the condition when a patient has waiting years or even decades to seek care. Thus, for the best possible outcome, please have a doctor of chiropractic evaluate your wrist and hand symptoms sooner rather than later.

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055
Member of Chiro-Trust.org

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Carpal Tunnel Syndrome Exercises

7 Aug

There are nine tendons that pass through the carpal tunnel at the wrist that connect the forearm muscles to the palm-side of the fingers. These tendons are encased in sheaths, and friction and heat can build-up inside these sheaths, leading to swelling, pressure, and pain (especially during fast, repetitive tasks). As the swelling increases and pressure builds up inside the tight space of the tunnel, the median nerve is pushed into the transverse carpal ligament, which serves as the floor of the tunnel, resulting in the symptoms we commonly associate with CTS. Stretching helps reduce this tightness and friction.

The stretching exercises listed below can BOTH help CTS as well as prevent it from occurring or re-occurring. As a warm-up:

  • Rotate the wrist in multiple directions—up, down, side-to-side, and figure 8s.
  • Spread your fingers as wide as you can and pull the fingers back using your other hand (or a wall) keeping the elbow straight.
  • Repeat step two, but this time, stretch the thumb back.

Repeat these steps five to ten times—enough to feel the forearms and hands loosen up.

The Prayer: Place your palms completely together like you are praying (keep the heels of the hands together) next to your chest and slowly lower the hands toward the floor while keeping the hands close to your body. Hold for 15-20 seconds.

Forearm Flexors: Arm straight, palm against the wall, fingers point downward, reach across and gently pull the thumb back. Hold for 15-20 seconds.

Forearm Extensors: Arm straight, back of the hand against the wall, fingers pointing downward. Hold for 15-20 seconds.

Repeat the above exercises three to four times and focus on feeling the muscles “release.” Try to do this three to five times a day, ESPECIALLY during the busy work day to “break-up” the monotony of fast, repetitive work tasks that can increase heat and friction in the sheaths surrounding the tendons that pass through your wrist.

Your doctor of chiropractic may recommend ice cupping over the wrist/s (palm side) and using a night splint on the affected wrist/s, in addition to exercises (like those above) and job modifications aimed at reducing CTS risk. Treatment may also include the use of manual therapies applied to the forearm, wrist, and hand, as well as the elbow, shoulder, and neck as these areas are frequently involved and must also be addressed to optimize the patient’s outcome.

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 103
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Important Carpal Tunnel Syndrome Facts

6 Jul

Carpal tunnel syndrome (CTS) occurs as the result of the median nerve being trapped or squeezed as it passes through the carpal tunnel, which is located in the wrist. Nine flexor tendons with their covering or sheathes, blood vessels, and connective tissue also pass through the carpal tunnel, creating a tight passageway between the forearm and hand. Therefore, swelling of tendons and/or their sheathes, leaking of synovial or joint fluid from the many carpal joints, or bone spurs, cysts, and/or systemic swelling can each impinge on the median nerve. Basically, ANYTHING that increases the pressure inside the tunnel can cause the symptoms associated with CTS.

Symptoms associated with CTS include pain, numbness, tingling, a “half-asleep” feeling, swelling, and a weak grip (such as difficulty unscrewing the lid from a jar). Sleep interruptions are common as we often sleep with a bent wrist, which further increases the pressure on the various soft tissues in the area.

Some people have a greater risk of developing CTS. For example, women are three times more likely than men to develop the condition due to a smaller tunnel and wrist as well as a slightly different tunnel shape. The following can increase the risk of developing or worsening CTS: diabetes, hypothyroidism, birth control pills and/or other hormonal replacement therapies, pregnancy, and some types of inflammatory arthritis.

Jobs that require fast, repetitive work without enough rest time and those that require forceful gripping also carry an increased risk for CTS. Ergonomic factors such as certain job tasks, tool handle shape, body position on a line or machine, prolonged sitting (especially when the head/neck is not in a neutral position), and work that requires telephone use (especially without headsets), must be addressed to gain proper control of the condition.

The diagnosis of CTS is made from a combination of a careful history and physical examination of the hands, arms, shoulders, and neck, as it is VERY IMPORTANT to make sure it is truly CTS and not a group of conditions or something totally different. Hence, your doctor may run a series of tests to differentiate between the many possible causes of CTS. Typically, a careful evaluation can lead to a successful diagnosis of CTS but occasionally, further tests are necessary.

The chiropractic treatment approach for CTS includes the typical rest, ice, night splints, exercises, and job modifications that most healthcare providers utilize. The unique feature that separates chiropractic from medical-based, non-surgical care is the use of manual therapies applied to not only the forearm, wrist, and hand, but also frequently the elbow, shoulder, and neck, as these areas frequently contribute to the patient’s symptoms and must also be managed for a successful outcome.

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org