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Can Carpal Tunnel Syndrome Be Caused By Your Job?

6 Aug

Carpal tunnel syndrome (CTS) is a common complaint, with symptoms ranging from subtle numbness to extreme pain and disability in the hand/wrist that can force a change in a worker’s vocation. According to the current research, the cause of CTS is the compression of the median nerve as it travels through the carpal tunnel at the wrist, which can be the result of repetitive motions involving the wrist, physical injury, and/or conditions like inflammatory arthritis, diabetes, pregnancy, and more. In other words, anything that reduces the tunnel’s size can result in median nerve compression and hence, carpal tunnel syndrome.

Researchers have found that industrial jobs that require repetitive, forceful work—those that involve heavy tools, for example—increase the risk for CTS, but the evidence isn’t as clear regarding jobs that involve repetitive motions with limited force, such as typing on a keyboard.

According to one Danish study that monitored the wrist health of 5,600 technical assistants, computer keyboard use may not be a likely cause of CTS. While the study did find that 11% of the workers experienced tingling or numbness in one or both hands, only 5% were considered to have developed CTS based on their overall description of symptoms—which is similar to what would be found in the general population. The study did find that using a mouse for twenty or more hours per week increased the risk for CTS.

However, that is not to say that working at a computer all day does not cause pain or strain in the hand/s, wrist/s, forearm/s, shoulder/s, or the neck. As mentioned above, just over half of the workers who experienced symptoms like tingling or numbness in the hands did not meet the diagnosis criteria for CTS.

Dysfunction anywhere along the course of the median nerve from the neck, shoulder, and elbow to the wrist can place pressure on the nerve and result in symptoms that mimic CTS. Doctors of chiropractic are trained to evaluate and treat the whole person in order to identify problems that either mimic or contribute to the symptoms associated with carpal tunnel syndrome. In many cases, a patient may not experience satisfying and lasting results unless problems elsewhere in the neck, shoulder, elbow, or lower arm are also addressed.

 

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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Carpal Tunnel Syndrome and Sports

5 Jul

Carpal tunnel syndrome (CTS) is the most common and well-known entrapment neuropathy, or pinched nerve in the extremities. Many people think that carpal tunnel syndrome (CTS) affects only computer workers or assembly-line workers, but that is far from the truth. Though CTS can affect anyone, it’s quite common in athletes. Surprised? Let’s take a closer look!

Many sports—including golf, tennis, cycling, and baseball—require a firm grip, high repetition, and little to no rest time, which can exceed the capacity of the soft tissues in the wrist. Over time, this stress can build and place pressure on the median nerve, resulting in the symptoms of pain, numbness, and tingling that are often associated with CTS. Additionally, trauma to the wrist from a sports collision can lead to the rapid development of CTS symptoms.

The diagnosis of CTS is typically made by combining a group of findings rather than by one definitive test. The patient’s history and symptoms coupled with the results from several provocative tests, which are easily performed in the office, are typically needed to arrive at an accurate diagnosis. Because CTS can co-exist with other conditions, of which several mimic similar signs and symptoms of CTS, an electromyography and/or nerve conduction velocity test can be extremely helpful.

In addition to therapies such as mobilization and manipulation to the wrist and other anatomical locations along the course of the median nerve (the elbow, shoulder, neck, for example), treatment by a doctor of chiropractic often includes the following non-surgical methods: wearing a wrist splint, primarily at night; using anti-inflammatories such as ginger, turmeric, and bioflavonoids; making modifications to the sport (if possible); managing vocational and avocational factors that place stress on the wrist; working with other healthcare providers to manage conditions like diabetes, hypothyroid, or certain types of arthritis that can cause or contribute to CTS; and training the patient in specific exercises that can be interspersed throughout the day.

It is very important to stress that EARLY INTERVENTION for CTS typically yields the best outcomes. So please, DO NOT WAIT before seeking care when you experience pain, numbness, or tingling in the wrist, hands, or fingers!

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.

What Isn’t Carpal Tunnel Syndrome?

7 Jun

Numbness in the hand is a common problem that we’ve all had at one time or another, and unless it becomes frequent, we usually don’t worry too much about it. When it starts to wake us up at night, that SHOULD get our attention! Since carpal tunnel syndrome (CTS) is one of the most common causes of hand numbness, that must be it, right? Not necessarily!

CTS is caused by pinching of the median nerve as it travels through a sometimes too tight boney tunnel made up of the eight small carpal bones at the wrist. But there are two other nerves that arise in the neck and travel down the arm to the hand that may be the culprit, one of which is the ulnar nerve (the other is the radial nerve).

When the ulnar nerve is entrapped near the humorous, it creates a condition called cubital tunnel syndrome (CuTS). It’s during the examination that a doctor of chiropractic can determine if the culprit behind a patient’s hand symptoms is the median nerve, the ulnar nerve, or even both nerves.

Diagnosis can become tricky, as there are other causes of whole hand numbness such as diabetic neuropathy or an injury to a network of nerves closer to the neck called the brachial plexus. More commonly, cutting off the blood supply in the upper, inner arm will make the whole arm (not just the hand) numb and feel “dead” until it “wakes up,” which may take a few minutes for the blood to percolate back into the arm and hand.

CuTS can occur from repeatedly applying pressure to the pinky-side of the elbow, such as leaning on the elbow against a hard surface, keeping the elbow bent too long (such as talking on a cell phone), resting the arm or elbow on the sill of a car door with driving, and/or maintaining prolonged awkward positions, like playing a musical instrument such as a flute or violin. Baseball pitchers throwing too many sliders and curve balls are also at increased risk of developing CuTS.

Like with CTS, the longer you wait before seeking treatment for CuTS, the longer it may take to recover (or in some cases, full recovery may not be possible) so if you’re feeling numbness, tingling, or pain in one or both hands, please consult with a doctor of chiropractic right away!

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.

Can Carpal Tunnel Syndrome Be Prevented?

7 May

Let’s say you’ve applied for a job that requires frequent gripping and handling of products and you heard that carpal tunnel syndrome (CTS) is a problem at this particular manufacturing plant. You really need the job, but you are leery of the possibilities of developing CTS. Is there anything you can do to PREVENT it?

Though there are no “guarantees” that CTS won’t occur despite our best efforts at prevention, here are some practical approaches that can make a big difference:

  1. LIGHTEN IT UP: CTS risk increases as a result of three things: Force + Speed + No Rest. First, try using less force or lighten up on your grip whenever possible. Though it’s hard to change habits, try gripping tools less tightly (use higher quality tools if they reduce the need to squeeze hard), don’t “pound” the keys of your keyboard, don’t squeeze your computer mouse, kitchen utensils, etc. and don’t strangle your golf club, tennis racquet, garden tools, or steering wheel. Use lighter-weight tools/utensils at home or work.
  2. TAKE BREAKS: Take 30-60 second stretch breaks every 15 minutes to allow the soft tissues in the hands and wrists to recover.
  3. STRETCH 1: Place your palm on the wall/desk pointing your fingers downward and stretch your wrist as far back as possible (elbow straight) until you feel the “pull” in the forearm muscles. HOLD for five to ten seconds and repeat on the other side. STRETCH 2: Make a fist for three seconds, then straighten out the big knuckle joints of the fingers (make a “bear claw”), followed by opening the hands and fanning out the fingers as far as possible. Hold each position for five to ten seconds and repeat as time allows.
  4. KEEP THE WRISTS NEUTRAL: When possible (driving a car, sleeping, etc.), keep your wrists straight/avoid bending. Use a wrist splint at times to help remind you (especially at night).
  5. CHANGE YOUR ROUTINE: Instead of staying at a risky task until you’re done, switch to a task that doesn’t require extreme gripping and force and/or switch between the left and right hand.
  6. CHECK YOUR POSTURE: Keep the chin tucked in (retracted) and head back. Avoid forward head posture and sit up “tall.” At a desk, keep knees, hips, elbows at 90°, and arch the lower back—in other words, don’t slouch!
  7. AVOID COLD HANDS: Try to avoid letting your hands and fingers get cold. Wear gloves (if possible), have a small space heater nearby, or rub your hands together. Even fingerless gloves can help a lot.
  8. ROTATE BETWEEN TASKS: Discuss rotating between job tasks with co-workers and your boss to avoid the same repetitive movements during your shift. This can really help in assembly line work.

SEEK HELP SOONER RATHER THAN LATER: Heed the early warning signs of CTS. Do NOT let CTS advance without seeing a chiropractor, as studies show that waiting too long reduces the success rate of treating CTS! Your doctor of chiropractic can teach you exercises, retrain your posture, suggest ergonomic (work) improvements, and treat your overused muscles and joints.

 

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.

CTS and Other Causes of Hand Numbness

12 Apr

Carpal tunnel syndrome (CTS) occurs when the median nerve is compressed at the wrist. However, there are other anatomical locations in which the median nerve can experience interference, and the median nerve is not the only nerve that ventures into the hand. So if you experience a symptom like hand numbness, CTS may not be the culprit…

After CTS, the next most common nerve pinch is the ulnar nerve at the inner elbow, which is technically called “cubital tunnel syndrome” (CuTS). This is often caused from over-use of the arm such as lifting and/or gripping with the palm up. The unique difference between CuTS and CTS is that the pinky and ring finger are affected but NOT the index, middle, and thumb-side ring finger, which are the median nerve-innervated fingers affected by CTS. Because over-use is also a common cause of CTS, these two conditions can co-exist, in which case all five fingers may be affected but not necessary all at the same time.

The shoulder is yet another fairly common location for a pinched nerve and is referred to as “thoracic outlet syndrome” (TOS). The most common nerve pinched here affects the fourth and fifth fingers, similar to CuTS; however, with TOS the upper arm is also affected, not just the elbow to the inner hand.

Another relatively common location for a pinched nerve affecting the arm is at the neck, often from a herniated disk and/or an arthritic spur where the nerve exits the spine. Depending on which nerve is compressed and the amount of compression, the numbness/tingling can affect different parts of the arm and/or hand.

Doctors of chiropractic are trained to differentiate between these various “syndromes” and to safely deliver treatment to the affected joints, muscles, and other soft tissues to reduce pain and restore proper motion so patients can return to their normal activities of daily living.

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 – OVERVIEW (Part 2)

12 Mar

This discussion picks up from last month as we review the “nuts & bolts” of carpal tunnel syndrome (CTS). We left off at “CLINICAL PRESENTATION”…

CLINICAL PRESENTATION (continued): A weakness in grip and pinch strength usually follows an initial loss of sensation in the second to fourth palm-side fingers. The intensity of weakness is more dependent on the amount of pressure versus duration of time of numbness. In other words, if a high degree of pressure suddenly occurs inside the carpal tunnel (like a fracture with bleeding into the tunnel), the patient may feel weakness right away. But usually, CTS is a slow, smoldering condition and if weakness occurs, it comes on slowly and most patients cannot say for sure when their weakness symptoms started.

PHYSICAL EXAM: It is important to assess other possible areas for neurological compression, such as the neck, shoulder (thoracic outlet), elbow, and/or forearm. Also, it’s necessary to rule out “co-morbidities” or other conditions that contribute to CTS. The list is long but includes diabetes, hypothyroid, pregnancy/birth control pills/recent menopause, kidney disease, arthritis, Lyme disease, multiple sclerosis, and more. The physical exam may also include a sensory exam and a motor exam as well as specific orthopedic provocative tests that can reproduce CTS symptoms. Your doctor may also order an EMG/NCV (electromyography/nerve conduction velocity) but NONE of these tests are 100% sensitive and specific—that is, there are false-positives and negatives. Lab and blood tests can help tease out some of the other possible conditions (listed above). X-ray, MRI, CT scan, and ultrasound may help identify spurs, fracture, cysts, and other space occupying causes of CTS, but no one test is enough.

TREATMENT: Chiropractic offers manual therapies such as manipulation, mobilization, massage, and myofascial release of not just the wrist and hand but also the cervical spine, shoulder, elbow, and forearm regions, if the median nerve is impeded in places beyond the wrist. Doctors of chiropractic often utilize night splints and recommend rest, job modifications, and anti-inflammatory agents such as ginger, turmeric, bioflavonoid, and proteolytic enzymes. Because being overweight can increase one’s risk for CTS, lifestyle improvements aimed at cutting excess mass may be recommended as well. MDs may prescribe anti-inflammatory drugs and help manage co-morbidities such as diabetes, hormone replacement, hypothyroid, and the like. Often, a coordinated “team approach” of care providers works best. Surgery may be necessary in some cases but usually ONLY after all the above fails.

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.