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Short-Term Care for Carpal Tunnel Syndrome

9 Nov

While the primary driver for carpal tunnel syndrome (CTS) may sometimes be hormonal changes (hypothyroid, pregnancy, or birth control use), type 2 diabetes, or an inflammatory condition (rheumatoid arthritis, psoriatic arthritis, or gout), many patients’ hand and wrist symptoms are caused by musculoskeletal issues that place pressure on the median nerve or restrict its motion. The good news is that chiropractic care is a great fit for the CTS patient, but how much care is needed before the numbness, tingling, weakness, and pain starts to resolve?

In one study that included 22 CTS patients, 19 of whom had CTS in both hands and wrists, researchers observed that the application of only manual therapy techniques to the hand, wrist, and forearm three times a week for two weeks led to significant improvements in pain, function, numbness, sensation, strength, and night awakening. The patients also performed better on the Phalen’s maneuver—a common clinical test used to stimulate CTS symptoms. Best of all, the participants continued to experience these improvements up to twelve weeks after their final treatment!

In addition to the manual therapies involved in the aforementioned study, doctors of chiropractic utilize additional non-surgical techniques such as nocturnal wrist splinting, at-home exercises/stretching, nutritional counseling, and job/ergonomic modifications. Dysfunction elsewhere along the course of the median nerve (such as the neck, shoulder, elbow, and forearm) may also need to be addressed.

If non-musculoskeletal causes are suspected, co-management with the patient’s medical doctor may be necessary. Though several studies have shown that surgical intervention may not be superior to non-surgical care over the long-term, a referral to a surgeon may be warranted if non-surgical treatment fails to produce a satisfying result. For CTS and other musculoskeletal conditions, many doctors of chiropractic will commence care with a short-term approach (such as six visits spread over two weeks, as used in the study discussed above) to evaluate how the patient responds to care and to adjust treatment recommendations from there. In mild cases, the patient may be released from care and advised to return on an as-needed basis. For chronic or severe cases of CTS, additional treatment may be required, though if the condition is too advanced, a full resolution of symptoms may not be possible. Hence, the importance of visiting your doctor of chiropractic for hand and wrist symptoms sooner rather than later!

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.

Nerve Mobility and Carpal Tunnel Syndrome

8 Oct

According to the American Medical Association Guides on the Rating of Permanent Impairment, if one loses the use of their thumb, index finger, and middle finger, they’ve lost 80% of the use of their hand. It’s no wonder why carpal tunnel syndrome (CTS)—a condition characterized by symptoms of numbness, tingling, pain, and weakness that affects these digits (in addition to half of the ring finger)—can be such a debilitating condition!

Peripheral nerves—such as the median nerve that travels from the neck to the hand—are arranged in a spiral manner, which provides them the ability to lengthen when the limb (arm or leg) is straightened without damaging the nerve fibers within the nerve. In a July 2020 study, researchers reported that median nerve mobility is restricted in patients with CTS, which suggests that the condition can be caused by factors that restrict the nerve’s ability to lengthen in accordance with normal movement. Thus, treatments that are geared toward improving nerve mobility are likely to benefit the CTS patient, and that’s precisely what one systemic review found.

Using data from four published studies, researchers reported that including nerve gliding exercises, also known as nerve flossing, with standard care for CTS led to better outcomes with respect to both symptom severity and hand function than standard care alone. Nerve gliding exercises are intended to move the nerve back and forth inside the tunnel and along its course to reduce pressure and friction.

Here is a sample nerve gliding exercise (one of several that your doctor of chiropractic can teach you) that can improve median nerve mobility:

  1. Stand sideways to a wall and place the palm of your hand on it, fingers pointing downward, elbow partially bent.
  2. Slowly straighten the elbow, feeling for the forearm to tighten up.
  3. Bend your neck sideways toward the wall when the elbow is straight and away from the wall when the elbow is bent and repeat.

Doctors of chiropractic often treat CTS patients with a multimodal approach that includes manual therapies, nerve gliding exercises, nocturnal wrist splints, activity modification, and supplemental/dietary changes. These approaches are all aimed at reducing pressure on the median nerve and to allow for nerve mobility to return to normal. If the patient history indicates that other issues—such as diabetes, hypothyroidism, and other conditions—may contribute to the patient’s symptoms, then co-management with a primary care doctor or other specialist may be required to achieve a successful treatment 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.

Who Gets Carpal Tunnel Syndrome?

14 Sep

Though carpal tunnel syndrome (CTS) affects 4% of the population, some individuals have a much greater risk for the condition, and several factors may need to be addressed to achieve a successful outcome.

Trauma: An acute trauma, such as a bone fracture, can lead to CTS. However, repetitive stress injuries are more commonly associated with the condition.

Anatomy: Not all wrists are equal, and some individuals, especially biological women, may have a narrower carpal tunnel, which increases the chances that the tendons passing through the region will become inflamed and compress the median nerve.

Arthritis: Osteoarthritis can cause spur formations that project into the tunnel and increase pressure on the nerve. Rheumatoid arthritis results in inflammation in the joints of the wrist and the lining around tendons, which can also place pressure on the median nerve as it passes through.

Hormones: Hormonal changes due to pregnancy, menstruation, menopause, birth control pills, hormone replacement therapy, diabetes, hypothyroid, kidney disease, lymphedema, etc. can lead to swelling or inflammation in the carpal tunnel, which can place pressure on the median nerve.

Medications: Certain medications can increase the risk for CTS such as anastrozole, a drug used in breast cancer treatment; diphosphonates, a class of medications used to treat osteoporosis; oral anticoagulants; and more. (When non-musculoskeletal causes are present, care may require co-management with the patient’s medical physician.)

Work Environment: Workplace factors that contribute to CTS include a cold environment, vibrating tools, awkward neck/arm/hand positions, no breaks, prolonged computer mouse work, and more. Individuals who work jobs characterized by fast, repetitive, and forceful, grip/pinch-related activities may be up to 2.5 times more likely to develop CTS.

Other Musculoskeletal Conditions: It’s possible for the median nerve to be compressed as it passes through the neck, shoulder, elbow, and forearm, which can stimulate CTS-like symptoms in the hand and wrist, even if there is no compression in the carpal tunnel itself. It’s also common for patients to have median nerve entrapment in one of these locations in addition to compression at the carpal tunnel. A patient’s doctor of chiropractic will need to review the patient’s health history and examine the entire course of the median nerve to identify all the contributing factors in order to achieve an optimal 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.

When to Seek Surgical Care for Carpal Tunnel Syndrome

6 Aug

Carpal tunnel syndrome (CTS) is a condition that occurs when the median nerve is compressed as it passes through the wrist. One treatment option available to patients is carpal tunnel release surgery, which severs the carpal tunnel ligament to reduce pressure on the affected nerve to resolve the numbness, pain, tingling, and weakness symptoms associated with CTS. When is surgical treatment for CTS necessary and when should a non-surgical option be pursued?

The short answer is that surgery should only be considered as a first option in an emergency situation, such as a serious wrist fracture that pinches the median nerve. Beyond that, treatment guidelines generally advise patients to exhaust non-surgical, conservative approaches before consulting with a surgeon. Aside from potentially higher healthcare costs and a prolonged recovery, surgery also carries the risk for serious complications. Another thing to consider is that the current research suggests that jumping straight to surgery may not necessarily produce better long-term outcomes than non-surgical treatment options.

In one randomized clinical trial, researchers recruited 120 female CTS patients to receive either surgery or a conservative treatment approach that involved manual therapies. The research team evaluated each patient after one month, three months, six months, and one year. In the short term—one month and three months—the results favored the conservative approach. However, both groups reported similar outcomes after six months and one year.

The same research team repeated the study with another group of female CTS patients and reported similar results. In the short term, conservative care achieved greater results while both approaches had similar outcomes over the long term.

A systemic review that looked at results from ten studies involving patients with confirmed CTS in one or both hands came to a similar conclusion. The review found that non-surgical care provided more satisfying results in the short term with both approaches achieving similar results over time.

While these studies show that conservative treatment to reduce pressure in the carpal tunnel is an effective option for the CTS patient, doctors of chiropractic will also examine the full course of the median nerve to identify other places the it may be compressed, such as the neck, shoulder, and elbow. Median nerve compression in these areas can often co-occur with CTS and will need to be addressed to achieve a satisfactory result.

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.

Repetitive Movement and Carpal Tunnel Syndrome

16 Jul

Of all the potential contributing factors for carpal tunnel syndrome—diabetes, thyroid dysfunction, inflammatory arthritis, pregnancy, birth control usage, and obesity—perhaps the most well-known is participating in jobs and activities that require fast, repetitive hand movements that can place increased pressure on the median nerve as it passes through the wrist. What can someone do if they begin experiencing tingling and numbness or pain and weakness associated with carpal tunnel syndrome without giving up their livelihood or their hobby?

First, understand that when the wrist is bent, the pressure on the contents of the carpal tunnel can increase substantially, especially when inflammation is present, which can affect the median nerve. So, if an activity frequently leads to numbness, tingling, or painful sensations in the hand and wrist, look for ways to maintain more neutral wrist posture. This may also involve using tools with a more ergonomic, wrist-friendly design. For the carpal tunnel syndrome patient, a doctor of chiropractic may also recommend wearing a splint overnight to keep the wrist from bending during sleep.

It’s also important to take frequent breaks (every 30 minutes, for example) to allow the affected wrist and hand to rest. Or if possible, switch to a different activity for a short time before returning to the task that places the greatest strain on the wrist.

Here are three great exercise options to improve finger, thumb, wrist, and forearm flexibility, which may stretch the soft tissues in the wrist and increase activity tolerance:

  1. Thumb-finger “push-ups”: Place the pads of your fingers and thumbs together in front of you and keep the fingers straight, spread apart, and pointing down. Push the hands together (try to touch your palms) and then push them apart by flexing your fingers and repeat. This stretches all five digits and the palm/forearm muscles ALL at the same time.
  2. Shake ‘em out: …as if you’re shaking your wet hands to dry them. Continue this for as long as one to two minutes every hour.
  3. Wall-stretches: Place your palm on a wall, elbow straight, fingers pointed down and push your palm flat into the wall as far as you can. Reach over and pull your thumb back off the wall with your other hand and hold for 20-30 seconds. Switch hands and repeat the stretch. This can be repeated two to three times per hand every hour.

Of course, consult with your doctor of chiropractic so that he or she can take a look at your patient history and examine the entire course of the median nerve to identify any other factors that may contribute to your carpal tunnel syndrome-associated symptoms.

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.

Manual Therapy vs. Surgery for Carpal Tunnel Syndrome

13 Feb

When people suspect they have carpal tunnel syndrome (CTS), it’s typical that their first thought is that their condition will require surgery and a lengthy recovery. While surgery may be warranted in emergency situations, treatment guidelines encourage patients to seek non-surgical options first. So how do non-surgical approaches like manual therapy interventions —provided in a chiropractic setting—compare with surgery to treat CTS?

In 2018, a team of European researchers reviewed data from ten studies that compared the effectiveness of surgery vs. non-surgical care for the treatment of CTS. While the results favored non-surgical approaches at three months and surgery at six months, the available data show no difference in outcome one year later. Thus, the research team concluded that conservative treatment should be preferred unless otherwise indicated.

If both surgery and non-surgical options produce similar outcomes at the one-year mark, can CTS improve on its own?

In one study that involved 22 patients (19 of whom had CTS in both hand), researchers incorporated a twelve-week waiting period into the experiment to see if symptoms worsened, stayed the same, or improved. Questionnaires completed by the participants who abstained from manual therapy interventions showed that their symptoms worsened during the twelve-week non-treatment period.

The treatment phase of the study involved six sessions twice a week for three weeks and incorporated manual therapies to address the soft tissues of the hand and wrist and the carpal bones. The patients reported that treatment resulted in improvements with respect to both pain and function. This led the researchers to recommend manual therapy interventions as a valid non-surgical treatment approach for CTS. Doctors of chiropractic specialize in manual therapy techniques and employ these regularly for many neuromusculoskeletal conditions, including CTS and related conditions that may contribute to a patient’s hand and wrist symptoms—something that a carpal tunnel release procedure cannot address. To achieve optimal results, it’s important to seek PROMPT assessment and non-surgical treatment for CTS.

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.