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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.

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.