Pain Relief Chiropractic

Carpal Tunnel Syndrome (CTS) basically occurs when pressure is applied to the median nerve as it travels through the wrist on the palm side resulting in numbness, tingling, pain, and later, weakness of the grip and pinch functions. But, the median nerve can be pinched at many other locations as it courses down from the neck to the hand, which is why we examine and treat the CTS patient from the neck down! The median nerve has been described as the “eye of the hand,” as it is one of the three major nerves formed from the brachial plexus– that “highway” of nerves made up of the C5-T2 roots leaving the neck, merging together to eventually form the three main nerves of the arm. Because the median nerve function regulates pinch and grip strength, buttoning a shirt, writing a note, driving a car, and even sleeping are ALL affected by a median nerve pinch. But WHAT is CTS? Let’s take an “inside” look!

We know that fast, repetitive motion-related jobs like meat or fish packing plants, assembly line work, sewing occupations, and the like can cause CTS over time. Look at the palm side of your wrist and wiggle your fingers. Do you see ALL THE MOVEMENT that is occurring just before the wrist in the forearm? That motion is coming from the tendons, which like shoe strings, attach the forearm muscles to the fingers. Notice ALL the movement in your forearm muscles closer to the elbow – that’s a lot of motion! There are nine tendons that are covered by a lubricating sheath that help the fast moving tendons reduce friction, thus decreasing the chances for heat build up, swelling (inflammation), and subsequent pain and loss of function. But, there is a limit or threshold that the tendons and sheaths can withstand before they just can’t keep up. These nine tendons and sheaths are quite tightly packed together as they leave the forearm and enter the carpal tunnel.

The carpal tunnel is made up of eight small wrist bones called the “carpal bones,” and ANYTHING that makes that tunnel more narrow can effectively cause CTS. If we look at what happens INSIDE the tunnel in the CTS patient, the venous blood flow and nerve flow (called “axonal transport”) is blocked when the PRESSURE inside the tunnel occurs. We all know what it feels like when a blood pressure cuff is inflated on our arm – if it’s pumped up too high or left on too long, the arm REALLY HURTS! That’s because the blood can’t get past the inflated cuff and oxygen can’t get to our muscles and tissues past the cuff and IT CAUSES PAIN!

To give you an appreciation of the pressure difference between the normal vs. CTS wrist, normally, the pressure ranges between 2 and 10 mmHg. We pump up a blood pressure cuff to about 150-200 mmHg when we take blood pressure, so this is NOT MUCH! This 2-10 mmHg pressure increases when we change the position of our fingers, wrist and forearm with wrist extension (bending the hand backwards), causing the greatest pressure increase. This is why we fit the CTS patient with a wrist “cock-up” splint to be worn at night since you can’t control your wrist position when you sleep and any bent position increases the pressure and can wake you up due to numbness, tingling, pain prompting you to shake and flick your hands and fingers until they, “…wake up.” When CTS is present, the pressure inside the tunnel goes up exponentially, meaning NOT 2 or 3 times, but 6, 12, 24 times what is normal and even higher! Now, if you add wrist bending (extension > flexion), the pressure REALLY gets high and it doesn’t take long for the nerve pinch and blood loss to wake us up. We’ve previously talked about other conditions that can make developing CTS more common or make it worse like hypothyroid, diabetes, arthritis, kidney disease, and more. AGAIN, this is because an increase is pressure results from these conditions (increased swelling = increased pressure = increased symptoms). As chiropractors, we will guide and manage your care through the healing process of CTS using a conservative, NON-SURGICAL treatment approach – TRY THIS 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) was first reported in the late 1800’s and the first surgery was noted in 1933. In the beginning, CTS surgery was rarely performed, reportedly because the nerve pinch was present somewhere before the median nerve reached the wrist or carpal tunnel. In brief, possible compression sites include the cervical nerve roots (C5-7), the brachial plexus, thoracic outlet, above the elbow, in the proximal and/or mid forearm, and finally at the wrist / carpal tunnel.

Estimating the frequency of CTS is challenging due to the fact that the pinch or entrapment may include more than one area before the wrist resulting in double and multiple crush syndromes. One European study reported the incidence of CTS at 5.8% in women and 0.6% in men while another reported 3.4% in the United States. Even the causation of CTS is all over the board. For example, the annual incidence of CTS in automobile workers ranges between 1-10%, while in a fish processing plant, it was reported to be as high as 73%! To make this even more challenging, the cause of CTS is commonly associated with other conditions such as diabetes and pregnancy. In diabetics, CTS ranges between 14% and 30% and those who are pregnant have a 2% incidence. Even harder to report is the incidence of median nerve pinching proximal to the wrist as this ranges between as little as 1% to as high as 75% for pronator tunnel syndrome in already symptomatic women. Gender is also a factor as women are reported to be four times more likely to develop CTS than men. If there is NO other condition associated with CTS, the term “idiopathic” is applied, and this reportedly occurs 43% of the time.

Another issue making CTS a challenge to diagnose is the many risk factors associated with it, and sometimes studies are published that contradict one another about the possible risk factors. There are studies that report CTS is more likely to occur with conditions including: 1) Jobs or activities associated with wrist flexion or extension; 2) Hysterectomy without ovary removal; 3) Obesity; and 4) Varicosities in men. Some studies indicate risk criteria such as: 1) Use of birth control pills; 2) Age at menopause; 3) Diabetes; 4) Thyroid dysfunction; 5) Rheumatism; 6) Typing; and, 7) Pinch grasping. One study reported the highest incidence to occur in those with previous wrist fracture (Colles’ fracture), and common conditions included rheumatoid arthritis, hormonal agents or ovary removal, diabetes, and pregnancy. Another study reported obesity and hypothyroid as being risk factors, but not all studies support that theory. Certain medications have been reported to be associated with higher CTS risk including: 1) Insulin, 2) Sulfonylureas (diabetes meds); 3) Metformin; and 4) Thyroxin.

As doctors of chiropractic, we perform a thorough history, examination, and offer MANY non-surgical, non-pharmaceutical ways of treating CTS. Some of these approaches include: 1) Joint and soft tissue manipulation of the neck, shoulder, elbow, forearm, wrist, and hand; 2) Wrist splinting, especially at night; 3) Vitamin B6 and anti-inflammatory nutrients; 4) Home exercises for the neck, arm and hand; 5) Work station / ergonomic evaluations; 6) Dietary counseling for various conditions listed previously; 7) Co-management with primary care, rheumatology, neurology, orthopedics, and others.

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.

Did you know that Carpal Tunnel Syndrome (CTS) can affect anyone? None of us are immune to developing CTS as roughly 1 out of 20 of us will develop CTS in our lifetime! This month, let’s look at some of the risk factors for developing CTS.

1) Race: Caucasians carry the greatest risk of developing CTS.
2) Gender: Women are three times more likely than men to develop CTS. This may be because female wrists are smaller and shaped a little differently than male wrists, but hormonal differences are probably the most important reason for this variance.
3) Pregnancy: Up to 62% of pregnant women develop CTS. This is thought to be due to the excess fluid retention that normally occurs during pregnancy and most likely stems from the elevation in hormone levels that NORMALLY occurs during pregnancy. The prevalence in the first, second, and third trimesters is 11%, 26%, and 63%, respectively, thus supporting the fact that the risk increases with the length of the pregnancy. Though CTS usually resolves after giving birth, symptoms can continue for as long as three years following delivery!
4) Birth Control Pill (BCP): The use of BCPs increases CTS risk due to an increase in hormonal levels similar to the CTS risk increase during pregnancy.
5) Occupational: Workers in highly repetitive, hand-intensive occupations (such as line work, sewing, finishing, meat processing, poultry or fish packing) have a higher rate of developing CTS.
6) Injury to the wrist or hand: An obvious example is a wrist fracture from a slip and fall, sports injury, or blunt trauma like a car accident. When there is a direct pinch on the median nerve, nerve damage can occur quite quickly, and as a result, the onset of symptoms can be very fast. Less obvious injuries, which usually have significantly slower onsets, include repetitive motion injuries, often referred to as “cumulative trauma disorders” and include a group of conditions such as tendonitis, sprain/strain, bursitis, and other types of soft tissue injuries.
7) Certain conditions: Nerve damaging conditions that can cause CTS include diabetes and alcoholism. Other conditions that can contribute and/or cause CTS include menopause, obesity, thyroid disorders, kidney failure, and more.
8) Inflammatory conditions: These include several types of arthritis such as rheumatoid, lupus, and others. Osteoarthritis is technically NOT an “inflammatory” condition but it can cause CTS by compressing the median nerve via a bone spur formed within the carpal tunnel.
9) Faulty work stations: A job site has A LOT to do with whether or not a person develops CTS. Though jobs that require fast, repetitive movements pose the greatest risk (see #5 above), other work-related factors that may be controllable can also significantly contribute to the development of CTS. Some of these include the shape of tools such as screwdriver handles shaped like a gun (pistol) which allow for better alignment of the wrist than a “normal” straight screwdriver handle. Another is a power tool that may have too much vibration or torques too hard at the end of a cycle. A handle that is too cold/hard (e.g., metal handle) or that may be too large for the worker’s hand is an additional factor to consider. Positioning the work so that the wrists can stay straight vs. bent can be VERY helpful. In fact, if some of these “ergonomic” factors are not fixed, CTS can be next to impossible to remedy. Also, poor posture in the back, neck, and the rest of the body can result in compensatory faulty postures elsewhere. Look in a mirror and poke your chin out towards the mirror. Now look at your shoulders. See how they roll forward and feel the strain in your upper back and neck? Keep your chin tucked in, NOT out. This can make a BIG difference in your posture!

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 a condition characterized by numbness, tingling, and/or pain located on the palm side of the wrist, hand and into the index, third, and half of the ring finger. It’s caused by pressure exerted on the median nerve as it passes through the “tunnel” located in the wrist. The “floor” of the tunnel is a ligament while the “walls” are made up of eight small carpal bones that lock together in the shape of a tunnel. There are nine tendons (tendons attach muscles to bones allowing us to move our fingers), sheaths covering the tendons, blood vessels, and the median nerve that ALL travel through the tunnel, so it’s packed pretty tight. ANYTHING that increases the size of any of these structures or anything “extra” that shouldn’t be there can increase the pressure inside the tunnel, pinch the median nerve, and result in the classic numb/tingling symptoms that wake people up at night, or interfere with work or driving.

In the Unites States (US), about 1 out of 20 people will suffer from CTS. Caucasians have the highest incidence rate and women are affected more than men by a 3:1 ratio between ages of 45-60 years old. Only 10% of the reported cases of CTS are under 30 years old. Occupational CTS (as of 2010) affects 8% of US workers with 24% attributed to manufacturing industry jobs. This equates to approximately 3.1 million cases of work-related CTS in 2010. The risk of developing CTS increases with age, diabetes, hypothyroid, pregnancy, taking birth control pills, having an inflammatory arthritis, being obese, pinched nerves in the neck, thoracic outlet, elbow, and others. Therefore, managing CTS requires a thorough evaluation in order to assure accuracy in the diagnosis. With this background information, let’s look at the question, WHAT CAN YOU DO TO HELP CTS? One answer is, don’t age – good luck with that! In addition to keeping your weight under control, exercise can be VERY effective and YOU can be in charge of that process, but we have to teach you the exercises.

1) The Carpal Stretch (“nerve gliding”): Place your palm on the wall near shoulder height with the fingers pointing down at the floor and press the palm of the hand flat on the wall. Lastly, reach across with the opposite hand and pull your thumb back off of the wall and hold for 5-15 seconds.
2) The Wrist Extensor Stretch: Do the same as #1 but place the back of the hand on the wall in front of you, again fingers pointing downward. Here, there is no need to stretch the thumb.
3) The “Bear Claw”: Make a fist and then open up the hand. Keep the small finger joints flexed while extending the knuckles at the base of each finger straight (not bent). Repeat 5-10x.
4) Putty Squeeze: Simply squeeze putty in your hand for two to five minutes until fatigued.
5) Yoga has been shown to reduce pain and improve grip strength in CTS patients!

Now the question, “…can these exercises prevent surgery?” The answer is “maybe.” They certainly help in some cases, but a multi-dimensional treatment plan is the BEST approach. This includes: 1) Chiropractic manipulation of the hand, wrist, elbow, shoulder, and neck; 2) Soft tissue “release” techniques of the muscles in the forearm, upper arm, shoulder, and neck; 3) Cock-up wrist splint to be used at night, and in some cases, at times during the day; 4) Ergonomic management of your work station or situation (to minimize repetitive insult to the area); 5) Nutritional support that may include an anti-inflammatory diet and nutrients (vitamins, minerals, herbs, etc.), and 6) Managing any contributing conditions like diabetes, hypothyroid, and/or the others. Here’s the GOOD NEWS: CHIROPRACTIC can manage these six steps, though some cases will require co-management with primary care and/or specialist.

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 a common condition usually associated with repetitive strain from jobs that require a fast, constant movement of the arms and hands (such as working on an assembly line). Up to 9% of adult women develop CTS and the incidence increases after age 50. A common medical treatment approach has been a combination of drugs (including corticosteroids), diuretics, splinting at night, and modifying activities, often including a “light duty” status until the symptoms calm down. Prior to accepting surgery as, “…the only option left,” an “alternative treatment” approach of vitamin B6 (and of course, chiropractic manual therapies) is chosen by many. Many treatment approaches have been previously discussed; however, today, we’ll take a closer look at the vitamin B6 /CTS connection.

Research regarding the use of vitamin B6 or, pyridoxine, can be traced way back into the ‘70s and ‘80s when it was reported that B6 is involved in several metabolic pathways, including neural function (“neurotransmission”). This is how it helps CTS patients since CTS occurs as the consequence of a pinched (median) nerve at the wrist. Findings from the initial studies, though quite small in terms of the number of subjects, suggested B6 improved the symptoms of CTS (such as, numbness and tingling into the 2nd to 4th palm-side fingers) by raising the pain threshold (that is, the point when symptoms occurred). Another study reported improvements in pain scores and mild improvements in electromyography and nerve conduction velocity (EMG-NCV) studies. Another study reported that at least 7 patients in their study were B6 deficient when blood tested. Regarding the dose, one study reported that taking only 2mg of B6 was enough to improve the patient’s CTS symptoms, but 100mg was needed for the avoidance of surgery. In a large “retrospective literature review” of 994 CTS patient files, it was reported that when 494 patients were treated with 100mg twice a day, the rate of symptom alleviation was 68%, much higher than group that did not receive B6 (only 14.3%). Yet, controversy is still reported about the effectiveness of B6 and firm conclusions are lacking. Despite this uncertainty, 200 mg of vitamin B6 is frequently included as part of the non-surgical “package” (along with NSAIDs like ibuprofen, nighttime splints, and an ergonomic workstation evaluation).

So, how much B6 is “enough?” The recommended daily intake is only 2 mg or less for all ages, genders and lifestyles with an upper limit set at 100 mg/day. The main toxicity issue is sensory neuropathy, which (oddly) is very similar to the symptoms caused by CTS! The good news is that CTS symptoms rapidly disappear at doses < 1000 mg/day and most studies indicate no toxic neuropathy by taking doses between 40 and 500 mg/day. Hence, it is recommended to never exceed 500mg/day and most recommendations are in the 100-200 mg/day range. If symptoms improve, a gradual reduction in the dose after about 3 months is advised. Closer monitoring of symptoms in those taking >200mg/day is recommended, especially since the symptoms of toxicity and CTS are so similar. Other B6 toxicity symptoms include depression, fatigue, impaired memory, irritability, headaches, altered walking, and bloating. So, keep your eyes open if doses >200mg/day are taken. Other micronutrients to consider that are anti-inflammatory in nature include omega 3 fatty acids, vitamin D, magnesium (often in combination with calcium), Co-Q10, proteolytic enzymes, and herbs such as ginger, tumeric, boswellia, white willow bark and more.

We realize you have a choice in who 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 require care for CTS, we would be honored to render our services.

Carpal Tunnel Syndrome (CTS) is a condition where a nerve in the wrist gets pinched resulting in numbness, tingling and sometimes grip strength loss. One of the first symptoms of CTS involves waking up at night due to the numb, tingly sensations. This initially occurs once in a while but  eventually  becomes more frequent, leading to very un-restful, sleepless nights. Most people do not initially attribute this sleep interruption to CTS but rather report, “…it’s coming from sleeping on my arm or lying in a funny position.” Because restful sleep is a very important health issue, this early CTS symptom should prompt the person to investigate the problem, but usually they wait, sometimes for months or even years, making treatment more challenging.

Other symptoms may include waking up in the morning with wrist and/or hand pain, difficulty buttoning a shirt or threading a needle, radiating arm symptoms into the forearm, shoulder and/or neck, dropping silverware, pens, coffee cups, and, a specific pattern of numbness such as the index, middle, and part of the ring finger. The degree of functional loss varies from none to total disability, not being able to work or carry out many home activities. Some people notice the symptoms during the day while performing fast, repetitive movements such as playing piano, typing, using a computer mouse, crocheting/knitting, writing, assembly work, and more. Some of the most frustrating complaints from CTS patients are lost work time (due to both CTS symptoms and fatigue from not sleeping at night), a loss in earnings, lack of dexterity (buttons, tying shoes, turning a key in a door or car, fixing hair, applying make-up), daytime grogginess, and irritability that can impact their quality of life, including their relationships.

A question that often arises is, what is carpal tunnel syndrome? A simple answer is “tendonitis” or, inflammation of the tendons that connect the muscles on the palm side of the forearm (flexor muscles) to their respective tendons that attach in the hand and fingers. Digging a little deeper, there are nine of these tendons that travel through the tunnel, rubbing together as we move our fingers and all is usually well unless there is too much friction resulting in swelling in this confined space. In fact, CTS remains silent until the swelling starts pushing or compressing the median nerve at which point the numbness, tingling, pain, etc., are noticed.

So, the next question is, what can be done to stop the inflammation from compressing the nerve? A very common treatment approach is the use of a cock-up splint at night, which stops us from bending the wrist in our sleep. In a normal, non-CTS wrist, the pressure in the carpal tunnel increases 2-fold when we bend our wrist; however, if inflammation already exists inside the carpal tunnel, the pressure increases by many multiples. This is why sleep interruption is so common in CTS as we just can’t control our wrist position at night. Another common anti-inflammatory approach is cortisone shots into the carpal tunnel and/or taking an anti-inflammatory drug like ibuprofen. The chiropractic answer to anti-inflammation is ice (preferably ice massage over the palm side wrist) and anti-inflammatory nutrients such as ginger, tumeric, boswellia, and others. What gives chiropractic the “edge” over non-surgical medical care is the addition of joint and soft tissue manipulation of the hand, wrist, forearm, elbow and when needed, the shoulder and neck. The latter improves circulation, reduces fixation or adhesion between tissues and allows the tendons to slide with less friction resulting in better function as noted by longer ability to play piano, type, write, etc.

Another “key” item to CTS treatment is identifying and finding a solution to a poorly designed workstation so the wrist/hand does not have to work in an awkward manner. Here, the position of a computer screen, how a tool is held, and how long repetitive work is allowed are modified.

We realize you have a choice in who 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 require care for CTS, we would be honored to render our services.