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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.
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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.

Two GREAT Treatment Options for Carpal Tunnel Syndrome

8 Jul

Carpal tunnel syndrome (CTS) has long been recognized as an occupational disease, and though the incidence of many other occupational diseases has decreased over time, CTS appears to be becoming more prevalent.

A 2019 study looked at the impact/benefit of wrist-specific exercises and oral enzyme therapy on automotive assembly line workers with CTS (excluding those treated previously or who had a positive history of hormone replacement or current pregnancy, inflammatory joint disease, trauma to the affected hand, polyneuropathy, other relevant conditions).

Participants in the exercise group performed the following exercises at home for nine weeks:

  • Deep “push & pull”: Massage the palm-side of the wrist using the thumb from the opposite hand for 30 seconds.
  • “Prayer Position”: Place the palms together in front of your chest; press the fingers slowly against each other for five seconds and release for five seconds; press the palms together and then slowly lower the hands toward the floor. Repeat as tolerated, gradually increasing reps.
  • Neuromobilization: Stand sideways to a wall; place the palm of the left hand on the wall, fingers pointing back to a “10 o’clock” position. Start with the elbow bent and slowly straighten it while bending the head sideways toward the wall (left). Slowly bend the elbow and bend the neck/head to the right. Repeat six to eight times with each hand.

The enzyme group took oral enzymes (which are known for their anti-inflammatory, anti-edematous, and analgesic effects) that included 2,000 mg pancreatin, 900 mg bromelain, 1,200 mg papain, 480 mg trypsin, 20 mg chymotrypsin, 200 mg amylase, 200 mg lipase, and 1,000 mg of rutin for nine weeks divided into two doses a day.

Compared with a third group that continued their usual activities, participants in both the enzyme and exercise groups reported improvements with their CTS symptoms. Nerve conduction velocity tests also revealed improved function in the median nerve.

Doctors of chiropractic commonly utilize a multi-modal approach when treating CTS, which often include manual therapies, nutritional recommendations, exercises, activity/modifications, and overnight wrist splinting.

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.

Factors That Can Hinder Carpal Tunnel Syndrome Recovery

6 Jun

As with most musculoskeletal conditions, treatment guidelines for carpal tunnel syndrome (CTS) recommend non-surgical or conservative management initially, with surgery only in emergency situations or after non-surgical options are exhausted. So, is there a way to know who will respond best to non-surgical approaches?

To answer this, researchers conducted a two-stage study that included an initial evaluation followed by non-surgical treatment and a re-evaluation one year after non-surgical treatment concluded. The primary goal of the study was to assess factors contributing to the long-term effects of non-surgical treatment of CTS and to identify failure risk factors.

The study involved 49 subjects diagnosed with CTS, of which an occupational cause was identified in 37 (76%). Because some patients had CTS in both hands (bilateral CTS), a total of 78 hands/wrists were included in the study. Treatment included a total of ten sessions of whirlpool massage to the wrist and hand, ultrasound, and median nerve glide exercises performed at home. The subjects were divided into three age groups: <50, 51-59, ≥60 years old.

While most patients experienced significant improvement in both stages of the study, some did not. Patients with more severe cases, as evidenced by poor results on a nerve conduction velocity (NCV) test, were less likely to respond to care, which underscores the importance of seeking care for CTS as soon as symptoms develop. Furthermore, participants who continued to overuse their hands at work or who did not modify their work procedures or workstation to reduce the forces applied on the hands and wrist were less likely to report significant improvements at the one-year point. Interestingly, age was not found to be a significant risk factor, which is surprising, as past studies have reported that being age over 50 is a risk factor.

Not only are doctors of chiropractic trained in the same non-surgical treatment methods used in this study, but they can combine such approaches with nutritional counseling (to reduce inflammation) and manual therapies to improve function in the wrist and other sites along the course of the median nerve to achieve the best possible results for their patients.

 

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.

Treatment on the Wrist for Carpal Tunnel Syndrome

6 May

When treating patients with carpal tunnel syndrome (CTS), doctors of chiropractic can employ a variety of options to reduce pressure on the median nerve. While this can include dietary recommendations (to reduce inflammation), adjustments to address dysfunction elsewhere along the course of the median nerve, or even working with other healthcare providers to manage conditions that contribute to CTS (like diabetes), treatment will often focus on the wrist itself.

One such approach is referred to as neurodynamic techniques, or mobilization. In a study involving 103 patients with mild-to-moderate CTS, those who received treatment twice a week for ten weeks experienced greater improvements with respect to pain reduction, symptom severity, functional status, and nerve function than participants in a control group who received no treatment. The authors concluded, “The use of neurodynamic techniques in conservative treatment for mild to moderate forms of carpal tunnel syndrome has significant therapeutic benefits.”

This finding is supported by two previous studies that found the use of manual therapies on the wrist can alter the shape of the carpal tunnel itself and allow more room for the tendons, blood vessels, and median nerve.

Additionally, studies show that when the wrist moves beyond a neutral position, it can alter the shape of the carpal tunnel and increase pressure on its contents. In a healthy wrist, full extension/flexion can double pressure in the carpal tunnel; however, for CTS patients, the pressure can increase as much as 600%. That’s why many treatment guidelines recommend wearing a wrist splint (especially at night) and modifying work and life activities to keep the wrist in a neutral position as much as possible.

The good news is that in most cases of CTS, patients will benefit from a conservative treatment approach; however, achieving a successful outcome can be more difficult if the patient delays treatment. That’s why it’s important to consult with your doctor of chiropractic when you experience the signs and symptoms associated with CTS (pain, numbness, tingling, or weakness in the hands or fingers) 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.

How Does Wrist Position Affect the Carpal Tunnel?

11 Apr

Carpal tunnel syndrome (CTS) is the most common “peripheral neuropathy” (pinched nerves in the arms or legs) and is known to be caused by prolonged repetitive, forceful grip-related tasks involving the hands. The condition occurs when pressure is placed on the median nerve as it passes through the carpal tunnel, either from inflammation, mechanical injury, or both.

The position of the wrist and hand are very important, as the pressure inside a healthy wrist “normally” doubles when we bend the wrist/hand. However, when CTS is present, the pressure doesn’t double at the extreme end-ranges of motion. Rather, when inflammation is present, pressure can increase up to six times at the end-ranges of motion! This can be highly problematic at night because we don’t have much control over how we position our wrist. Not only can increased pressure on the median nerve cause you to wake up but it can set the stage for worsening symptoms in both the short and long term. This is why doctors often advise CTS patients to wear a night splint and to avoid prolonged awkward wrist positions during the day when working.

In a 2014 study involving 31 healthy college students, researchers used ultrasonography to measure median nerve deformation as participants bent their wrists and performed finger movement-intensive movements. Investigators observed that the median nerve flattened out with as little as 30º of wrist extension and became swollen after students performed rapid mobile-phone keying for five minutes with a corresponding increase in the cross-sectional area of the carpal tunnel. In a follow-up experiment, the research team found that the motion involved with clicking a mouse repeatedly had an even greater effect on the median nerve. The authors concluded that the increased use of electronic devices, especially in non-neutral wrist positions, increases the risk of CTS.

A literature review performed in the same year came to a similar conclusion: prolonged exposure to non-neutral wrist postures increased CTS risk by at least twofold.

In order to reduce pressure on the median nerve, doctors of chiropractic often use a combination of wrist splinting, patient education (including tool/workstation modifications), nutritional recommendations, and manual therapies. In many cases, this can lead to a successful outcome without the need for more invasive treatments. However, when necessary, your chiropractor can refer you to the appropriate provider and/or co-manage the condition with them.

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.