Pain Relief Chiropractic

What does the thyroid gland have to do with carpal tunnel syndrome (CTS)? The short answer is, a lot! But the “how” requires a more detailed explanation…

The carpal tunnel is made up of eight small bones in the wrist that form a tunnel, with the “floor” of the tunnel located on the palm side of the wrist. CTS is caused by the median nerve getting pinched as it travels through the carpal tunnel, which results in numbness and tingling into the middle three fingers (index, third, and fourth) initially, and usually weakness of the grip later.

The thyroid gland is located at the base of the neck just below the “Adam’s Apple” (which is really thyroid cartilage). There are two “lobes” located on either side of the windpipe (trachea), and a small bridge of thyroid tissue crosses over the front connecting the two lobes (called the “isthmus”) in most of us.

The thyroid belongs to the endocrine system, which is controlled by the pituitary or “master” gland that is located inside the head. These glands secrete hormones into the bloodstream that influence the body in a variety of ways. Some of the other “members” of the endocrine system include the adrenals, the parathyroid, the gonads (testicles or ovaries), the insulin producing part of the pancreas, the mammary glands, and more. Think of the endocrine system as a “team” and the pituitary gland as the “coach.”

The thyroid’s role on the endocrine “team” is to release hormones (primarily T3 and T4) that regulate our metabolism/metabolic rate (digestion, heart rate, breathing, body temperature, etc.).

It’s been known for a long time that thyroid disease—particularly low thyroid function—increases one’s risk for developing CTS. One thought is that the type of swelling that occurs with hypothyroid (called “myxedema”) places enough pressure on the median nerve to pinch it, resulting in the classic signs and symptoms of CTS.

More recently, researchers used ultrasound to measure the size of the median nerve (called the cross-sectional area or CSA) in 30 patients with newly diagnosed primary hypothyroidism and comparable “normal” controls (similar size/BMI, similar gender, and age). In those with hypothyroidism, the cross sectional size of the median nerve was larger than those measured in the normal group, and four of the hypothyroid patients already began experiencing CTS signs and symptoms. After receiving treatment to restore their thyroid levels, both the size of the median nerve was reduced and the symptoms that were present resolved within three months.

This study points out the significant relationship between the thyroid and its effect on CTS. Doctors of chiropractic treat the mechanical causes of CTS very successfully, but they may rely on the expertise of a “team” of healthcare providers to treat the patient when necessary.

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
 4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org

 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 (CTS) is caused by the compression of the median nerve as it passes through the wrist, which can result in pain, numbness, tingling, and in some cases, a weak grip.

At first, these symptoms are mild and infrequent, but over time can become more intense, frequent, and last longer. Most people don’t react to these initial warning signs, which is too bad because CTS is MUCH easier to treat in its early stages.

Risks for developing CTS include: 1) female (primarily due to hormonal shifts and smaller carpal tunnel size); 2) jobs requiring forceful gripping (carpenters, tradesmen) and/or fast repetitive work (line assembly, poultry/meat packing jobs, typists/transcriptionists); 3) illnesses (diabetes, hypothyroid, inflammatory arthritis); 4) pregnancy; 5) sports injuries (trauma); and more.

Non-surgical care from most doctors includes the use of a nighttime wrist splint to stop the wrist from bending during sleep and anti-inflammatory measures like ice. Methods unique to chiropractic include the above PLUS neck, shoulder, elbow, wrist, and hand manipulation, mobilization, and muscle release techniques. Exercise training and education is very important as well—all of which help chiropractic stand out when it comes to non-surgical care options.

Serious warning signs that indicate a more advanced case include: 1) A long-standing history of problems (often years). 2) Severe symptoms. 3) Muscle atrophy caused by prolonged nerve deficit from the pinched median nerve. (Look at the pad on the palm-side at the base of the thumb—if it’s smaller in size and “flaccid” or has less muscle tone compared to the other side, that’s a possible sign of muscle atrophy.)

So if you are having early warning signs of CTS, PLEASE consult with a doctor of chiropractic as soon as possible! It’s MUCH easier to achieve a successful outcome if you start treatment BEFORE muscle atrophy and severe, long-standing symptoms occur!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for Carpal Tunnel Syndrome, we would be honored to render our services.

 YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR CARPAL TUNNEL SYNDROME!  FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Carpal Tunnel Syndrome (CTS) is a VERY common condition where the median nerve is compressed or squeezed as it passes through the wrist. One reason that it’s so common is because MANY daily activities require fast, repetitive use of the fingers, hands, and arms, and the friction of the rapidly moving muscle tendons inside the tunnel results in swelling and compression of the nerve. So, can CTS really be prevented?

There are many factors associated with CTS, and some risks can be prevented. For example, some conditions like diabetes, rheumatoid arthritis, and IBS increase the risk of CTS. Therefore, it would be safe to assume those who better manage such conditions would have a lower risk for developing CTS.

Due to the many factors associated with CTS, there is no “one size fits all” when it comes to treatment and prevention of CTS. With that said, here are some VERY effective methods:

1) Ergonomic workstation modifications: Altering the work space (monitor height, keyboard/mouse style, different chair, chair/desk height, etc.) to reduce the number and speed of movements needed to perform commons work tasks.

2) Rest periods: Insert “micro-breaks” into a busy task. Combine breaks with stretching exercises of the wrist/hand/fingers and vary job tasks between fast and slow repetitive types.

3) Exercise: Shake the fingers and hands, lean back in a chair with the arms/shoulders stretched back (“Brugger’s Exercise”), move the neck (chin tucks, rotations, etc.), bend the hand/wrist backwards on a wall or the desk’s edge, self-massage and deep tissue release of the forearm and hand muscles. Do regular aerobic exercise (walking, swimming, biking, etc.) several times each week.

4) Posture: Sit up straight, elbows about 90° on height-adjustable arm rests or comfortably at the sides, forearms parallel to the floor; knees level or slightly lower than the hips, feet flat on the floor or on a footrest or box, if needed. Place typing materials at eye level / avoid prolonged head/neck rotation. Use a wrist rest for the keyboard and mouse, and use a headset when on the phone.

5) Reduce hand tool forces: Choose a tool that allows the wrist to remain neutral. Avoid side to side and flexion/extension wrist positions—especially if they’re prolonged! Tool handles should NOT dig into the palm of the hand or the wrist, and should not have sharp edges. A textured handle can improve grip. Minimize vibration from power tools. Wear shock absorbing gloves. Avoid cold work environments and cold tools.

6) Diet: Cut down on caffeine and smoking. Avoid obesity—a known risk factor of CTS! Consider an anti-inflammatory diet (Paleo, Mediterranean).

7) Splints: A wrist cock-up splint at night prevents prolonged faulty positions and REALLY helps!

This is a partial list of preventative measures that can REALLY help. Doctors of chiropractic treat the WHOLE person and can teach you the right exercises, ways to modify your diet, offer manual therapies and modalities, and help guide you in your self-management of CTS, as this can be a lifelong affliction. A multi-modal treatment approach generally works best!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for Carpal Tunnel Syndrome, we would be honored to render our services.

Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy—that is, it’s the most common place to trap a nerve in the extremities (arms or legs). CTS affects 6-11% of adults in the general population, and it occurs in women more often than men. The cause is often difficult to determine but the most common reasons can include trauma, repetitive maneuvers, certain diseases, pregnancy, being over the age of 50, and obesity.

So, is surgery the only answer? The short answer is NO! In fact, in a recent randomized clinical trial published in the Journal of Pain, researchers observed similar improvements in function when they compared the outcomes of patients who underwent surgery vs. those who received manual therapies (such as those performed several times a day at chiropractic clinics around the world) at both six months and one year later. The improvements included increased strength, function, and decreased hypersensitivity in both the surgical and non-surgical groups. Interestingly, the manual therapy group did BETTER at the one and three month assessments when compared with the surgical group (again, with no difference at six and twelve months)!

The median nerve, the culprit behind CTS, starts in the neck and travels down through the shoulder, elbow, forearm, and finally through the carpal tunnel, which is made up of eight small carpal bones that form the arch of the bridge. Entrapment of the median nerve occurs when the normally tight quarters within the carpal tunnel combine with the inflamed nine sheathed muscle tendons that push the nerve into the floor of the tunnel (a ligament), which results in CTS! The goal of therapy—both surgical and manual therapy—is to reduce the pressure within the tunnel and free up the compression of the median nerve.

Manual therapies focus on joint mobilization and manipulation to reduce joint fixations, muscle release techniques in the forearm and hand, stretching techniques, and at-home exercises that emphasize a similar stretch, the night brace, and management of any underlying contributing factor. These “underlying factors” might include diabetes, hypothyroid, taking birth control pills, weight management, and inflammatory arthritis.

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for Carpal Tunnel Syndrome, we would be honored to render our services.

For those who have carpal tunnel syndrome (CTS), it’s no surprise that CTS is frequently most expressive during the night, often to the point of interrupting sleep and/or making it difficult to fall back to sleep. So why is that?

The primary reason for nighttime CTS symptoms has to do with the wrist, as it is very difficult to sleep with the wrist held in its “ideal” or least irritating position. In fact, most people favor “curling” the back of the hand under the chin or bending the hand/wrist backwards under the head. When the wrist is bent in either direction, it can increase the pressure inside the wrist, which can generate the various symptoms associated with CTS.

One study evaluated the pressure inside the carpal tunnel while participants slowly moved their wrists. The researchers found many movements didn’t need to exceed 20 degrees before the pressure increased enough within the carpal tunnel to generate symptoms.

Because it doesn’t take a lot of movement to build up excessive pressure in the wrists of those with CTS, many doctors recommend the use of a “cockup splint” for the nonsurgical
treatment of CTS in order to help keep the wrist in a neutral position.

Wrist posture is also an important factor during the day. One study looked at typing on a tablet PC, which allowed people to work in nontraditional settings. As screen size reduced, the posture required to type became more limited and accelerated the usual rate of pain onset in the neck, elbows, and wrists.

This study also looked at three different positions used when working on touchscreen devices: desk, lap, and bed. The healthy subjects completed six, 60-minute typing sessions using three
virtual keyboard designs: standard, wide, and split. The researchers monitored the position of the wrist, elbow, and neck while the participants typed and followed up each session with questionnaires designed to measure discomfort.

The research team reported that typing in bed required greater wrist extension but resulted in a more natural elbow position than typing at a desk. The angled split keyboard significantly reduced the wrist deviation vs. the standard or wide keyboard designs. All three regions—the neck, elbow, and wrist—exhibited more movements (13% to 38%) towards the end of the one hour sessions, which correlated with a significant increase in pain in every body region investigated. Overall, using a wider keyboard while sitting at a desk was the most tolerable position among study participants.

According to the literature, carpal Tunnel Syndrome (CTS) is one of the most prevalent upper extremity complaints. In fact, it IS the most common “compression neuropathy” (of which there are many) and affects 3-6% of adults in the general population. Additionally, CTS can affect BOTH hands in up to 50% of patients with the condition!

The CAUSE of CTS is often unknown and typically comes on gradually, making it difficult to determine a definite cause or specific “date of onset” for CTS.

Symptoms such as numbness, tingling, loss of dexterity, loss of strength (like pinch or grip), and the need to shake the hand or flick the fingers to restore sensation are ALL VERY COMMON CTS SYMPTOMS. The REASON for these symptoms boils down to one thing: The median nerve in the wrist gets pinched! The cause/s can include:

• Repetitive motion from either work or hobbies like assembly line work or playing a musical instrument can cause swelling within the carpal tunnel, placing extra pressure on the median nerve as it passes through.
• Obesity can contribute to CTS due to extra fluids or fatty deposits that can build up within the carpal tunnel.
• Pregnancy: Elevated levels of the hormones estrogen and progesterone can cause the body to retain fluids and increase pressure in the carpal tunnel.
• Arthritis: Osteoarthritis can lead to CTS (such as when a spur forms inside the tunnel). Rheumatoid arthritis can lead to an autoimmune response and antibodies that end up attacking the cartilage of the joints in the wrist, which can lead to CTS.
• Hormone-related conditions: In diabetes mellitus, the blood becomes thicker due to high sugar levels (like syrup) and can’t pass through the small blood vessels, resulting in “neuropathy,” which can make CTS more likely. In hypothyroid, low thyroid function results in “myxedema,” a specific type of swelling that makes CTS more likely to occur.
• Trauma: A wrist fracture could cause the carpal tunnel to “collapse” or change in shape resulting in less space for the nerve to travel through.
• Mass lesions: A “ganglionic cyst” is a good example. This is where joint fluid leaks out and forms a “bump” on the INSIDE the carpal tunnel, which reduces space and increases pressure in this anatomical structure.
• Amyloidosis: This is a rare condition where a protein substance called “amyloid” builds up in any tissue or organ. If this occurs in the wrist, it can “pinch” the median nerve as it passes through.
• Sarcoidosis: This is the growth of small collections of inflammatory cells called “granulomas,” which can accumulate in different parts of the body. If it occurs in the wrist, pinching can occur.
• Multiple Myeloma: This is a type of cancer that affects the bone marrow, and inflammation in the wrist can occur creating the pressure increase on the median nerve that can lead to CTS.
• Leukemia: This too is a type of cancer that involves the white blood cells, and CTS can result from its effects on the tissues in the wrist.
• Anatomy: The size and shape of the carpal tunnel is hereditary, and some of us have a smaller tunnel than others. If CTS is present in multiple family members, this “genetic” factor may play a role.

There are other conditions that can “mimic” CTS, but doctors of chiropractic are trained to perform an accurate history and examination so treatment can be directed in the proper manner!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for Carpal Tunnel Syndrome, we would be honored to render our services.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR CARPAL TUNNEL SYNDROME! FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888