Pain Relief Chiropractic

Carpal Tunnel Syndrome (CTS) is an EXTREMELY common condition that can affect anyone at any age. In fact, there’s a strong probability that up to 50% of the people reading this today have or have had symptoms of CTS at some point in time and 10% or more have been treated for it! We have recently discussed various non-surgical treatment approaches for managing CTS but the question of WHY exercises should be included in that program remains a mystery to many!

In review of the anatomy of the carpal tunnel, we’ve got nine tendons that are the “shoe strings” that connect the muscles in the palm-side forearm to the fingers traveling through the tunnel along with the infamous MEDIAN NERVE — the culprit creating the numbness and tingling associated with CTS. The bony “roof” of the tunnel is made up of eight carpal bones that connect our forearm to our hand and allow us to bend the wrist in many directions. Without these eight little bones, we would not be able to bend our wrist at all! The “floor” of the tunnel is the transverse carpal ligament, and the median nerve lies directly on top of it. CTS occurs when the contents within the tunnel swell and apply pressure that pushes the median nerve into the floor, which is common when the wrist is bent, such as when sleeping with our hand curled under our chin at night – hence the reason for a night splint (cock-up brace) to prevent nighttime bending.

Now that we have a picture of the tunnel in our mind, exercises for CTS will make more sense. CTS occurs when forceful, repetitive tasks are performed over a lengthy period of time (examples include practicing a musical instrument, assembly line work, carpentry, etc.). The FRICTION between the tendons (“shoe strings”) inside the tunnel creates swelling and that results in tightness.

EXERCISE #1 is ICING using an ice cube or frozen Dixie cup of water and rubbing it over the tunnel. First you will feel COLD, then BURNING, then ACHING, and finally NUMBNESS (“C-BAN”). Quit at numbness as the next stage of cooling is frostbite! Many of you may not look at “ice massage” as an exercise, but it’s very important!

EXERCISE #2 – Stand near a countertop, place the palm-side of your fingers on the edge of the counter and push until your wrist is bent backwards as far as you can stand it while keeping your elbow straight. Now reach across with your other hand and pull your thumb backwards as far as possible. Can you feel the “pull” in your mid forearm up to the elbows? GOOD! Hold that for three to five seconds, rest for five seconds and repeat it three times. Do this on both sides, even if the other hand is “normal” so you can feel the difference between the “tight” CTS side vs. the normal arm. CTS is often bilateral so you may not notice a difference. Now, set the timer on your smartphone to ring every hour to remind you to do this throughout the work day.

EXERCISE #3 is the fist / “bear claw” / hand open sequence. First, make a tight fist, followed by opening your hand while keeping the fingers flexed/bent, followed by opening the hand and fingers fully. Hold each position for two to three seconds and go through the sequence as often as needed (usually two to three times a session, multiple times a day) and do BOTH sides at the same time.

Why do these help? They break up adhesions between the tendons, their sheaths, and the surrounding tissues, and these exercises also force you to take “mini-breaks” during a busy day, which can reduce swelling in the carpal tunnel.

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.

Have you ever woken up at night with numbness and tingling in your fingers and had to climb out of bed and shake your hands, flick your fingers, and/or rub your arms to “…wake them up?” Well, you’re not alone! In fact, this is one of the more common and often one of the FIRST symptoms of Carpal Tunnel Syndrome (CTS). So, WHY does this happen?

The “carpal tunnel” is literally just a tunnel that MANY components of the body travel through on the way to the hand. The walls are made from eight small “carpal” bones and the “floor” of the tunnel is made by the transverse carpal ligament. These structures vary in size and shape and differ between males and females, which may be one reason CTS is more common among women than men. The contents of the tunnel include eight tendons that connect the muscles in the forearm to the index, third, ring, and pinky fingers. A ninth tendon that connects to the muscle that flexes the thumb also travels through the tunnel along with blood vessels. Perhaps most importantly, the median nerve that supplies sensation and strength to the palm side fingers (index, third and ring fingers) and the palm of the hand also travels through the carpal tunnel. The tendons to the fingers and thumb are “sheathed” and can swell due to the friction created by the tendon rapidly moving in the tight sheath. This is one reason why people who work in an occupation that requires fast, repetitive hand movements (such as assembly line work, carpentry, food preparation, for example) will often have problems with carpal tunnel syndrome.

The pressure inside the wrist normally doubles when it is fully bent either forwards or backwards. However, because there is already greater pressure in the affected carpal tunnel of individuals with CTS (due to swollen tendons, for example), the pressure inside the carpal tunnel can increase much more when the wrist is bent. This added pressure can exacerbate the symptoms normally associated with CTS — including numbness and tingling in the hands and fingers — especially when the wrist is bent for a prolonged period of time, such as during sleep.

Treatment associated with carpal tunnel syndrome includes the use of a night wrist cock-up splint, which keeps the wrist from flexing or extending during sleep and helps the swelling inside the carpal tunnel abate. Cock-up splints are not typically worn during the day, as they tend to interfere too much with normal activity and may actually worsen the condition depending on the length of time and the type of work the person is performing. Driving will often increase symptoms, and use of the cock-up splint can be effective during this time.

Chiropractic management offers a unique form of treatment called manipulation and mobilization that is applied to the fingers, hand, wrist, forearm, and any other area where nerve compression might be present, which frequently includes the cervical spine/neck region. The shoulder and elbow may also require care.

Anti-inflammatory measures including ice massage over the wrist and anti-inflammatory herbal preparations such as ginger, turmeric, and/or digestive enzymes taken between meals can help. Modifying the ergonomics of a CTS patient’s workstation is a good idea in order to reduce the repetitive strain commonly associated with chronic carpal tunnel syndrome.

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) develops when the median nerve is pinched at the palm-side of the wrist causing numbness in the index, third, and thumb-side half of the ring/fourth finger. Since the median nerve passes through the neck, it’s possible that dysfunction in the neck can interfere with the median nerve, resulting in carpal tunnel syndrome-like symptoms. Sometimes the median nerve can be “pinched” in both the neck and the wrist in what’s known as double crush syndrome.

Though many patients benefit from both surgical and non-surgical CTS treatment approaches, it is not uncommon for the results to fall short of a total resolution of symptoms. In these unsuccessful cases, it’s possible the median nerve is “pinched” at one or more locations other than the area the treatment focused on. In some cases, the hand symptoms and other signs of CTS can improve following treatment to relieve cervical dysfunction. The opposite can also be true with neck pain and related symptoms improving when the carpal tunnel is treated.

The concept of “differential diagnosis” has to do with considering multiple possible causes that can create similar symptoms, and one by one, ruling “in” or “out” each diagnosis by performing various tests with the ultimate goal of coming away with one solid diagnosis. Of course, the problem with this is that there is often more than one diagnosis at play, and in such cases we must determine which one is primary vs. secondary.

Taking our topic this month as an example, a chiropractor may often see cervical spine x-ray findings such as degenerative disk spaces, osteoarthritic spurring, or narrowing of the foramen that the spinal nerves pass through in route to the arm and hand. However, they may not be sure if these findings are “clinically important” or even contribute to a “cervical radiculopathy” or pinched nerve in the neck. It’s possible to see these same x-ray findings in patients with no radiating arm symptoms whatsoever. Similarly, patients with radiating arm / hand complaints may have NONE of these findings! The same holds true with bulging and/or herniated disks in the neck because these may or may NOT cause any radiating symptoms. When a chiropractor is able to reproduce arm and hand symptoms during an examination of the neck that are similar to CTS, this increases the doctor’s suspicion that at least a portion of the hand complaints may be attributed to nerve compression from the neck. When both neck and wrist findings co-exist, tests like EMG (electromyography) and NCV (nerve conduction velocity) can really help in some cases, but in other instances, the degree of nerve loss (the amount of damage) may not be enough to be accurately assessed with such diagnostic tools.

The “bottom line” is that all health care practitioners start “conservative” and wait until all approaches have been exhausted prior to recommending surgery. As described in previous articles, there are MANY non-surgical approaches that chiropractors can provide and you owe it to yourself to try these conservative approaches first!

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) develops from a nerve problem in the wrist (the median nerve) and is NOT a “muscle problem” like some people believe. That is not to say the median nerve cannot be trapped and pinched by muscles. When this occurs, the condition is labeled with a different name, depending on which muscle(s) are pinching the nerve or where the entrapment is located. Here are some more FACTS about CTS that you need to know:

SYMPTOMS: CTS complaints include numbness, pain, tingling, and/or weakness of the hand (especially fingers two, three, and four), and while this can be constant, it usually comes and goes.

ONSET: CTS usually comes on gradually. However, the length of time over which it progresses can be HIGHLY VARIABLE. It can take weeks, months, or even years before the patient consults with their chiropractor or family doctor.

CAUSE: There are MANY reported causes of CTS, but it is not completely known how the process starts out or how it evolves for different people. Risk factors include age greater than 50, obesity, genetics (family history of CTS), gender (as it favors females over males), work type (highly-repetitive, hand-intensive work), pregnancy, birth control pill usage, thyroid disease, diabetes, rheumatoid arthritis, and more. In general, swelling is the culprit that results in pressure on the median nerve. This most commonly occurs from overuse of the hands and fingers. Playing musical instruments, sewing, crocheting, basket weaving, assembly/line work, meat processing work, typing/computer work, and waitressing are common over-use activities.

CLINICAL COURSE: Early into the disorder, CTS is usually easily managed and reversible. However, if the amount of pressure on the nerve is too much, the symptoms can become permanent. Think of a wire and how wearing away the plastic coating will “short” the wire. There are multiple layers to our nerves and the wearing away of the outer layers over time can become a problem resulting in permanent numbness and/or weakness.

BIGGEST MISTAKE: Don’t wait until your symptoms are terrible! If you feel periodic numbness and tingling and you find yourself shaking your hand and “flicking” your fingers in attempt to “wake them up,” NOW IS THE TIME TO COME VISIT YOUR CHIROPRACTOR before nerve damage occurs and the risk of permanency increases.

HOW CHIROPRACTIC HELPS: Treatment guidelines for CTS recommend a non-surgical approach, and this is where chiropractic comes in! A wrist night splint is typically recommended since sleep interruption due to numbness is VERY common as we cannot control our wrist position when we sleep. Ice (not heat) is best as it reduces swelling (see #3 above). Rubbing an ice cube (or Dixie cup of ice) over the palm-side of the wrist works well. First, you will feel COLD followed by BURNING, then ACHING, and finally NUMBNESS (“C-BAN”). At this point STOP, as the next stage of cooling is frost bite! Do this three times a day or as directed. Your doctor of chiropractic will also talk to you about taking “mini-breaks” at home and/or at work and teach you exercises or stretches that can be performed during these breaks! A work station assessment is often very helpful as sometimes a simple change in work position or method can reduce wrist strain considerably. Your doctor of chiropractic may also perform manipulation to the small joints of the hand, wrist, elbow, shoulder, and neck as indicated in each specific case. He or she may also perform soft tissue release techniques to the muscles and soft tissues of the forearm, shoulder, and neck regions as needed. Surgery should be the LAST step in the treatment process, used only if all other non-surgical options have been tried without success.

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 one of the most common “peripheral neuropathies” patients have when they visit a chiropractor for the first time. Peripheral neuropathy (PN) is defined as “…damage or disease affecting nerves, which may impair sensation, movement, gland or organ function, or other aspects of health, depending on the type of nerve affected.” Let’s take a closer look!

Common causes of PN include systemic conditions such as diabetes, vitamin deficiency, medication side effects (such as chemotherapy meds), traumatic injury, after radiation therapy, excessive alcohol intake, an autoimmune disease such as rheumatoid arthritis, and/or viral infection. PN can be linked to an individual’s genetics that are present from birth. For others, it can be unknown which is then referred to as “idiopathic.”

PN can affect one nerve (mononeuropathy) or multiple nerves (polyneuropathy) and can be acute (which means it comes on quickly) or chronic (which means it comes on gradually over time and progresses slowly). PN symptoms can include cramp/charley horse-like pain, muscle twitching, muscle atrophy or shrinkage, numbness, tingling, pins and needles, burning or cold feeling, and can also affect other tissues such as bone causing degeneration, skin changes, and hair and nail changes. PN can also affect a patient’s balance and coordination which can increase an individual’s chances of falling. If organs or glands are also impacted, PN can lead to poor bladder control, heart rate or blood pressure changes, and/or affect the sweat glands.

Getting back to CTS specifically, one of the challenges of this condition is determining the cause/s. Here’s what we know about CTS: 1) it is more common in women than men; 2) it is more common in those who are overweight; 3) it is more common in those who work in highly repetitive environments; 4) it is more common over age 50; 5) it is often accompanied by other upper extremity “over-use” conditions like tendonitis in the hand, wrist, elbow, and/or shoulder and can also involve the neck (as CTS cases improve faster when treatment is also applied to the cervical spine); and 6) it commonly includes one or more of the conditions previously mentioned that can cause neuropathy such as diabetes and rheumatoid arthritis. Other conditions such as hypothyroid can also cause or worsen an existing case of CTS, in part due to “myxedema,” a type of swelling that occurs with this condition. Here, the additional swelling can add to the compression or pressure pushing on the median nerve in the carpal tunnel and either cause CTS or worsen an existing case.

Because CTS can have more than one underlying cause, it’s important that your doctor determine as many as possible in order to achieve the best treatment results. We’ve all heard of the cases that fail to respond to surgical intervention, which in many cases is because there were MULTIPLE CAUSES and only one was addressed with the surgical approach. Surgery has always been described as “the last resort” and indeed it’s appropriate in some cases. However, MANY CTS patients respond well to chiropractic management, which often includes (but is not limited to): 1) joint manipulation and mobilization of the hand, wrist, forearm, elbow, shoulder, and neck; 2) use of a night-time splint; 3) home/work exercises; 4) physical therapy modalities; 5) nutritional considerations; and 6) ergonomic modifications (work station assessment). If these approaches fail to achieve satisfying results, your doctor will refer you to a hand surgeon to determine which procedure might be best for you.

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.

Chiropractors are often asked, “Why does Carpal Tunnel Syndrome (CTS) bother me so much during the night?” Let’s take a look!

The carpal tunnel is made up of eight small carpal bones that bridge the forearm to the hand. Without these eight little bones, the motion at the wrist would be very restricted and limited to bending a little bit up and a little bit down. Think of all the things you are able to do with a large range of motion at the wrist like tightening a small screw by hand, pulling on a wrench, using a hammer, working under the dash or inside the engine compartment of a car, threading a needle, sewing, knitting, crocheting, and even washing dishes. As you can see, we put our wrists in some pretty strange positions!

Look at the palm-side of your wrist and wiggle your fingers. Do you see all that activity going on? Now, move your eyes slowly towards the elbow as you keep moving your fingers. It is pretty amazing how much movement occurs near the elbow just by moving the fingers! There are actually nine tendons that travel through the carpal tunnel, and these tendons connect your forearm muscles to the fingers. That’s why there is so much movement in the upper half of the forearm when moving your fingers, and in people with CTS, these muscles are usually overworked and super tight. This is why chiropractors work hard to loosen those muscles during treatment! These nine tendons are covered by a sheath, and friction between the tendon and the sheath is reduced by an oily substance called synovial fluid. When we repetitively and rapidly move our fingers, the friction that builds up produces heat, and if the oily synovial fluid can’t keep up, swelling occurs.

Any situation where there is increased swelling in the body can also promote CTS. For example, during pregnancy, hormonal shifts can result in a generalized swelling similar to taking BCP’s (birth control pills). Hypothyroid results in edema or swelling referred to as “myxedema” that can cause or make CTS worse. Some of the inflammatory arthritis conditions such as rheumatoid, lupus, scleroderma, and more can also predispose one to developing CTS. Obesity by itself is a risk factor for similar reasons.

So, why are we so susceptible to CTS symptoms at night? The main reason is that we RARELY sleep with our wrist in a straight or neutral position. We like to curl up in a fetal position and tuck our hands under our chin, bending the wrist to the full extent (90°). By doing so, the pressure inside the wrist “normally” doubles, but in the CTS patient, the pressure can increase by six times! This pinches the median nerve against the ligament that makes up the floor of the tunnel as it travels through the carpal tunnel, which then wakes us up and we find ourselves shaking and flicking our fingers to stop the numb, tingling, burning, pain that commonly occurs with CTS! This is why we prescribe a wrist brace for nighttime use and it REALLY helps! DON’T JUMP TO SURGERY FIRST – TRY CHIROPRACTIC FIRST!

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.