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The Chiropractic Approach to Carpal Tunnel Syndrome

6 Jan

Carpal tunnel syndrome (CTS) is a condition that occurs when pressure is applied to the median nerve as it passes through the wrist resulting in symptoms such as tingling, numbness, and weakness. Outside of an emergency leading to a sudden onset of such symptoms—like a broken wrist—surgery is rarely advised as a first-line treatment. In general, treatment guidelines recommend exhausting all non-surgical options before consulting a surgeon. So, what happens when a patient consults a doctor of chiropractic for CTS?

First, the patient completes paperwork regarding their current symptoms and their health history. The information provided will inform the doctor about the chronicity, frequency, and intensity of the patient’s symptoms. The history may also reveal conditions that are known to contribute to an elevated risk for CTS such as diabetes, birth control pill usage, pregnancy, hypothyroid, etc.

Next, the doctor of chiropractic will conduct a thorough examination, with added focus on the course of the median nerve. The median nerve arises from the spinal cord in the neck as nerve roots travel down through the shoulder, past the elbow, and through the wrist. If the nerve is compressed anywhere along this route, a patient may experience CTS-like symptoms, so it’s important to locate where the nerve is “pinched” in order to ensure the best chance for a positive outcome. To complicate matters, the median nerve may be compressed at several points, a condition referred to a double crush or multiple crush syndrome. Not only that, but the median nerve isn’t the only nerve that supplies sensation to the hand. When entrapped, the ulnar and radial nerves can also produce symptoms in the hand and these symptoms can be mistaken for CTS by the layperson because it’s the most commonly known peripheral neuropathy.

Once all the potential contributing factors to the patient’s hand and wrist symptoms are identified, the doctor of chiropractic will recommend a course of treatment that may involve manipulation, mobilization, therapeutic exercises, modalities, wrist splinting, and even dietary recommendations, depending on the patient’s unique situation. The goal is to reduce pressure on the median nerve by restoring normal motion in the affected joints, as well as in reducing inflammation that may be present from a variety of causes.

While patients with more severe cases of CTS can benefit from non-surgical approaches, like chiropractic care, it’s important to note that it may take longer for such patients to experience improvements in pain and disability, and it may not be possible to totally reverse the course of the disease if it has progressed too far. As with many conditions, the sooner a patient seeks care, the greater their chance for achieving a successful 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.

Can Carpal Tunnel Syndrome Be Hereditary?

9 Dec

Carpal tunnel syndrome (CTS) is a disorder caused by compression of the median nerve that alters the nerve’s function (neuropathy), leading to pain and numbness/tingling (paresthesia) primarily on the palm-side of the wrist and hand. While factors like hormonal changes and repetitive motions are known to increase the risk for CTS, there might be a genetic component to the condition.

It’s known that conditions that can elevate the risk for CTS—like diabetes, thyroid disease, rheumatoid or osteoarthritis, and obesity—can run in families. Additionally, the data show that having a family member with CTS raises the risk that you too can develop the condition, but it’s not entirely clear to what extent genetic traits are responsible versus shared environmental factors among family members.

In 2007, at the 74th Annual meeting of the American Academy of Orthopaedic Surgeons in San Diego, Harvard professor Dr. David Ring and colleagues presented their evaluation of 117 previously published studies to determine the strength of a “cause-and-effect” relationship for CTS using a scoring system that included both biological and occupational factors. Their analysis revealed that genetic risk factors were two times stronger than the evidence supporting occupational risk factors, such as overuse.

Dr. Barry Simmons, chief of the Hand and Upper Extremity Service at Brigham & Women’s Hospital reported that 75-80% of CTS found in women age 50-55 is idiopathic, or of unknown cause, further supporting genetics as the primary factor. Dr. Ring states, though the evidence suggests genetics are a risk factor for CTS, there may be epigenetic factors or environmental changes to genes based on certain foods eaten or certain activities might increase a person’s risk beyond their genetic makeup.  As of 2015, no epigenetic factors have been identified in idiopathic CTS.

The good news is that even if you have a family history of carpal tunnel syndrome, you can reduce your risk for developing CTS by managing any conditions or activities that can contribute to inflammation along the course of the median nerve. This includes maintaining a healthy weight, eating a low-inflammation diet, getting regular exercise, taking frequent breaks from repetitive tasks involving the hand, reducing exposure to awkward hand postures and vibratory forces, etc. If you are experiencing CTS-related symptoms in the hand and wrist, a thorough examination by a doctor of chiropractic can help identify potential causes and help you manage the condition so you can return to your normal activities as soon as possible.

 

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 101

11 Nov

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, or pinched nerve, in the extremities. The condition is estimated to affect 3-6% of the population, often in both hands. Let’s discuss what causes CTS, its symptoms, how it’s diagnosed, and how it’s treated…

Causation: Carpal tunnel syndrome occurs when pressure is placed on the median nerve as it travels through the wrist. This can be due to inflammation caused by obesity, repetitive movements, pregnancy, arthritis, hypothyroidism, diabetes mellitus, trauma, mass lesions, amyloidosis, sarcoidosis, multiple myeloma, leukemia, and more. Women are at a greater risk for CTS than men, due to having a smaller wrist and possibly hormonal reasons.

Symptoms: Pain, numbness, and tingling are common CTS symptoms that affect the thumb, index finger, middle finger, and the thumb-side of the ring finger. Symptoms can radiate up into the forearm and even into the shoulder and neck. Weakness in grip strength and nighttime/sleep interruptions are also common symptoms.

Diagnosis: The patient history is very important for diagnosing CTS, as it provides the doctor information to help determine if CTS is likely or if another condition is causing the patient’s symptoms, such as ulnar tunnel syndrome or dysfunction elsewhere along the course of the median nerve. The “flick sign” (flicking the fingers to “wake them up”) predicts electrodiagnostic abnormalities 93% of the time with a false-positive rate of <5%. Other in-office tests include provocative tests (reproducing symptoms), neurological tests for sensation (sharp vs. dull), and strength-muscle tests. More advanced electrodiagnostic tests (EMG/NCV or electromyogram/nerve conduction velocity) can quantify the severity of CTS and verify the diagnosis.

Treatment: All treatment guidelines recommend conservative, non-surgical care prior to surgery unless there is a unique, unusual case like trauma (fracture), or some other unusual situation. THIS IS WHERE CHIROPRACTIC SHINES! Besides “usual” non-surgical care (night splinting, anti-inflammatory measures, exercises, and ergonomic modifications), chiropractic treatment includes manual therapies such as soft tissue release techniques and joint manipulation. A 2018 study reported that following manipulative therapy, patients experienced an increase in the front-to-back diameter and roundness of their carpal tunnel, which reduced pressure on the tunnel’s contents. Chiropractors also perform manual therapy based on neurodynamic techniques, which a 2019 study concluded were highly effective in a group of patients with mild-to-moderate CTS.

It’s important to note that patients are more likely to achieve a successful outcome if they seek treatment earlier in the course of the disease than if they wait months or even years. If you experience the symptoms associated with CTS, seek care 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.

Great Exercises for Wrist Pain

14 Oct

There are many conditions that affect the hand and wrist: tendonitis (strains), ligament injuries (sprains), as well as carpal tunnel syndrome (CTS). A contributing factor for these conditions is inflammation caused by overuse and repetitive motions. That’s why your doctor of chiropractic recommend taking mini-breaks (30 seconds to one minute) throughout a busy workday to give the wrist a chance to rest. The following exercises are also helpful for self-managing wrist pain (in addition to chiropractic care):

 

  1. SHAKE: As if to dry off your wet hands, shake your arms and hands vigorously.
  2. FIST/BEAR-CLAW/FAN: This three-step exercise includes making a firm fist, then a bear-claw (bending only the ends or tips of the fingers/thumbs), and lastly, opening the hand wide and fanning or spreading the fingers out.
  3. THUMB-FINGER “O’s”: Make an “O” by touching the tip of the thumb to each of the four fingertips. Vary the speed and pressure. Mix it up.
  4. WRIST BENDS (OPTION #1): Sit or stand, elbow straight, palms up, and bend the hand toward you (fingers pointing up). Bend the wrist back so the fingers point down. Hold each position for about five seconds and repeat five to ten times. Repeat on your opposite hand to add pressure to the end-range stretch (to “super-stretch”).
  5. WRIST BENDS (OPTION #2): Repeat Exercise 4 but with the palms down.
  6. TENDON TETHER: Hold the arm out in front and bend the elbow 90°, palm facing you. Bend the wrist back so the palm faces upward. With the other hand, pull down on each finger while slowly straightening the elbow until the elbow is fully extended (arm straight) and hold for five seconds. REPEAT on each finger and thumb (both hands).
  7. WRIST RESISTANCE: Rest the forearm on the arm of a chair (elbow bent 90°) palm down, with the wrist and hand extended off the end of the arm (an edge of a table works too). Place the other hand across the knuckles (to form a “+” sign). First, raise the bottom hand against the resisting/top hand slowly through the full range of motion (ROM) and then reverse it by slowly lowering the hand while STILL RESISTING as you move back down toward the floor (full ROM). Repeat five to ten times slowly and repeat on opposite side. Perform the same exercise with the palm up and repeat on both sides.
  8. HAND SQUEEZE: Hold a soft rubber ball or a pair of balled up socks and slowly squeeze to a maximum tolerance and SLOWLY release it. One repetition should take at least five seconds. Repeat five to ten times with each hand.

 

When exercising, THINK ABOUT what you are doing (visualize the movement in your head) to enhance the neuromotor response for the best results. Your doctor of chiropractic can train you on these and many other exercises to facilitate CTS/wrist injury recovery.

 

 

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 Pregnancy

9 Sep

Carpal tunnel syndrome (CTS) is a condition that we typically associate with overuse activities, especially occupations that require fast, repetitive hand work such as typing, sewing, and packaging. However, the hormonal changes that occur in pregnancy can also lead to swelling or inflammation in the wrist, and subsequently, the symptoms associated with CTS.

A 2019 study involving 382 women in the third trimester of pregnancy revealed that 111 (23.03%) experienced the signs and symptom consistent with mild-to-severe CTS. Further analysis showed that the women who were older, left-handed, and had gestational diabetes mellitus were more likely to have severe CTS symptoms.

It makes sense to assume that pregnancy-related CTS would resolve once a woman has given birth, but another study suggests this isn’t always the case. In one long-term study, researchers monitored the status of 45 women who presented with CTS during their pregnancy. One year following the birth of their child, only 40% of the participants reported that their symptoms (pain, tingling, numbness) and function had improved. Half of the women reported no change in their symptoms or function and a small portion said their condition worsened (13.3% symptoms, 4.4% function). Nerve conduction testing showed no problems in 17.8% of participants, with the rest experiencing some degree of nerve interference.

At the three-year mark, 51% were symptom-free, while 49% were still symptomatic but less so compared to their situation at the start of the study and at the one-year follow-up.

In conclusion, although many women who develop CTS during pregnancy will experience improvement over time, almost half will continue to report symptoms and functional impairments up to three years after the birth of their child. Doctors of chiropractic offer a non-surgical, effective combination of management strategies that can be easily and safely applied during pregnancy and after delivery.  Because CTS can be highly disruptive to sleep and cause other quality-of-life issues, women with the condition should strongly consider chiropractic care during pregnancy and after if symptoms or problems persist.

 

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.

Chiropractic Management of Carpal Tunnel Syndrome

12 Aug

When someone is diagnosed with carpal tunnel syndrome (CTS), there seems to be an automatic assumption that surgery is imminent or at least inevitable. However, treatment guidelines for CTS that are intended to be followed by ALL healthcare professionals ALWAYS recommend an initial course of non-surgical treatment, NOT jumping directly to surgery. Unfortunately, evidence-based treatment guidelines are not always followed, and many patients are not given an option for anything other than surgery.

The following is an excerpt from a 2017 Washington State CTS treatment guideline:

All of the following criteria must be met for surgery to be authorized:

  1. The clinical presentation is consistent with CTS
  2. The EDS [electrodiagnostic studies] criteria for CTS have been met
  3. The patient has failed to respond to conservative treatment that included wrist splinting and/or injection

Medical-based non-surgical care for CTS includes: neutral position wrist splints worn at night and (in certain cases) at times during the day (studies report that 30-70% of patients respond favorably within several months of initial wrist splint use); glucocorticoids injections into the carpal tunnel (these can provide short-term relief with about 50% of patients requiring surgery within one year); and forearm and wrist exercises.

Doctors of chiropractic often use a combined approach based on the patient’s unique case, which can include wrist splints and exercise training (as described above) along with manual therapies like manipulation and mobilization on the wrist and elsewhere along the course of the median nerve; physical therapy modalities such as laser therapy, ultrasound, and pulsed electromagnetic field; nutritional counseling, especially anti-inflammatory herbs like ginger, turmeric, and Boswellia; and ergonomic medications such as changing a workstation setup or the grip on tools used to perform job functions.

Studies show that, in most cases, mild-to-moderate CTS can respond to non-surgical approaches just as well as surgery (though without the potential side effects associated with going under the knife), which underscores the importance of seeking care for CTS as soon as possible.

 

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.