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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.

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.