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Chiropractic Care for Chronic Carpal Tunnel Syndrome

11 Jan

Because the early symptoms of carpal tunnel syndrome (CTS) can be mild and tolerable, many patients put off seeing a doctor until the pain, numbness, tingling, and weakness in their wrist and hand is no longer bearable. The current research supports chiropractic care as an excellent non-surgical option for new-onset CTS, but what about patients with chronic CTS?

In a case series study of 18 women with chronic CTS (defined as CTS lasting more than six months), researchers looked at the potential benefits of soft tissue mobilization combined with nerve slider neurodynamic technique on pain and pressure sensitivity at various points along the course of the median nerve from the cervical spine into the hand before, immediately after, and one week following just a single treatment.

The treatment session consisted of a 30-minutes of soft tissue techniques (including soft tissue mobilization, nerve slider neuromobilization, myofascial release, stretching, and cross-fiber friction over the muscular interfaces through which the median nerve travels) at four locations: the front/side of the neck (anterior scalene muscles), the distal to middle anterior upper arm (biceps brachii), the proximal palm-side forearm (pronator teres), and stretching the transverse carpal ligament and soft tissues on the palm-side of the hand. The patients reported a reduction in pain following treatment that persisted for up to one week following just one treatment.

Another study looked at the long-term effects from manual therapies on patients with chronic CTS. In this study, patients received two treatments a week for three weeks. Not only did the patients report improvement in their CTS symptoms following the conclusion of care, but these benefits persisted when researchers followed-up with participants six months later.

Manual therapies are a primary treatment approach utilized by chiropractors for both acute and chronic CTS, along with many standard management strategies such as night splints, physical modalities, and specific home-based exercise recommendations. This multi-modal approach places chiropractic at the top of the list as the ideal choice for the CTS patient!

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.

Tools for Managing Carpal Tunnel Syndrome

7 Dec

In addition to manual therapies and specific exercises to relieve pressure along the course of the median nerve as it passes through the wrist and elsewhere, doctors of chiropractic may utilize other high- and low-tech tools to manage the condition:

  • Electric stimulation (e-stim) directs an electric current via electrodes placed on the skin over or near the painful area to either stimulate healing (higher frequencies) or reduce pain (lower frequency).
  • Pulsed electromagnetic field (PEMF) uses an electromagnetic field to reduce pain, lower inflammation and muscle spasm, stimulate healing, and facilitate nerve and circulatory function. (Note: This cannot be used in a patient with a pacemaker.)
  • Ultrasound uses sound waves that travel at 1-3 million cycles per second to cause cells to vibrate and produce heat leading to an increase in circulation and the stimulation of nerve cells to aid in the healing process. There is no sensation because the speed of the sound waves is far too fast.
  • Low level laser therapy (LLLT) uses a specific wavelength of light that penetrates the skin to produce therapeutic effects. The term photobiomodulation is often used to describe its beneficial effects—including accelerated tissue repair—and to reduced pain and inflammation. These devices use less than 0.5 watts and are classified as a class IIIb laser, while those this more than 0.5 watts are class IV lasers, which penetrate deeper.
  • Dietary modifications and supplement guidance may be offered since consuming foods/vitamins that reduce inflammation may aid in the healing process (Mediterranean diet, ginger, turmeric, Boswellia, etc.).
  • Ice reduces inflammation and is beneficial in the acute stages of CTS. This is most effectively applied by directly massaging the wrist/carpal tunnel with an ice cube. Heat may help in the chronic, less inflamed stages of CTS. Rub- or roll-on analgesics may offer short-term pain-reducing benefits.

How your doctor of chiropractic approaches your care will depend on your patient history and examination/diagnostic findings as well as their clinical experience. The good news is the conservative treatment approaches used by chiropractors are often very effective, but if necessary, your doctor of chiropractic can co-manage your condition with other healthcare providers.

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.

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.