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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.

Treatment on the Wrist for Carpal Tunnel Syndrome

6 May

When treating patients with carpal tunnel syndrome (CTS), doctors of chiropractic can employ a variety of options to reduce pressure on the median nerve. While this can include dietary recommendations (to reduce inflammation), adjustments to address dysfunction elsewhere along the course of the median nerve, or even working with other healthcare providers to manage conditions that contribute to CTS (like diabetes), treatment will often focus on the wrist itself.

One such approach is referred to as neurodynamic techniques, or mobilization. In a study involving 103 patients with mild-to-moderate CTS, those who received treatment twice a week for ten weeks experienced greater improvements with respect to pain reduction, symptom severity, functional status, and nerve function than participants in a control group who received no treatment. The authors concluded, “The use of neurodynamic techniques in conservative treatment for mild to moderate forms of carpal tunnel syndrome has significant therapeutic benefits.”

This finding is supported by two previous studies that found the use of manual therapies on the wrist can alter the shape of the carpal tunnel itself and allow more room for the tendons, blood vessels, and median nerve.

Additionally, studies show that when the wrist moves beyond a neutral position, it can alter the shape of the carpal tunnel and increase pressure on its contents. In a healthy wrist, full extension/flexion can double pressure in the carpal tunnel; however, for CTS patients, the pressure can increase as much as 600%. That’s why many treatment guidelines recommend wearing a wrist splint (especially at night) and modifying work and life activities to keep the wrist in a neutral position as much as possible.

The good news is that in most cases of CTS, patients will benefit from a conservative treatment approach; however, achieving a successful outcome can be more difficult if the patient delays treatment. That’s why it’s important to consult with your doctor of chiropractic when you experience the signs and symptoms associated with CTS (pain, numbness, tingling, or weakness in the hands or fingers) 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.

How Does Wrist Position Affect the Carpal Tunnel?

11 Apr

Carpal tunnel syndrome (CTS) is the most common “peripheral neuropathy” (pinched nerves in the arms or legs) and is known to be caused by prolonged repetitive, forceful grip-related tasks involving the hands. The condition occurs when pressure is placed on the median nerve as it passes through the carpal tunnel, either from inflammation, mechanical injury, or both.

The position of the wrist and hand are very important, as the pressure inside a healthy wrist “normally” doubles when we bend the wrist/hand. However, when CTS is present, the pressure doesn’t double at the extreme end-ranges of motion. Rather, when inflammation is present, pressure can increase up to six times at the end-ranges of motion! This can be highly problematic at night because we don’t have much control over how we position our wrist. Not only can increased pressure on the median nerve cause you to wake up but it can set the stage for worsening symptoms in both the short and long term. This is why doctors often advise CTS patients to wear a night splint and to avoid prolonged awkward wrist positions during the day when working.

In a 2014 study involving 31 healthy college students, researchers used ultrasonography to measure median nerve deformation as participants bent their wrists and performed finger movement-intensive movements. Investigators observed that the median nerve flattened out with as little as 30º of wrist extension and became swollen after students performed rapid mobile-phone keying for five minutes with a corresponding increase in the cross-sectional area of the carpal tunnel. In a follow-up experiment, the research team found that the motion involved with clicking a mouse repeatedly had an even greater effect on the median nerve. The authors concluded that the increased use of electronic devices, especially in non-neutral wrist positions, increases the risk of CTS.

A literature review performed in the same year came to a similar conclusion: prolonged exposure to non-neutral wrist postures increased CTS risk by at least twofold.

In order to reduce pressure on the median nerve, doctors of chiropractic often use a combination of wrist splinting, patient education (including tool/workstation modifications), nutritional recommendations, and manual therapies. In many cases, this can lead to a successful outcome without the need for more invasive treatments. However, when necessary, your chiropractor can refer you to the appropriate provider and/or co-manage the condition with them.

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.

How Does Chiropractic Help Carpal Tunnel Syndrome?

11 Mar

Carpal tunnel syndrome (CTS) occurs when pressure is placed on the median nerve as it passes through bones and ligaments of the wrist in order to innervate a portion of the hand. This pressure can be cause by compression of the carpal tunnel due to mechanical injury or when other tissues near the median nerve become inflamed, either from disease or overuse.

When it comes to treating a patient with carpal tunnel syndrome (CTS), what separates chiropractic care from standard medical care? Both options recommend night wrist splints, anti-inflammatory measures, rest, and the “tincture of time.” Doctors of chiropractic are trained to provide manual therapies like manipulation and mobilization. Two studies show that these therapies can relieve pressure on the median nerve by improving the shape of the carpal tunnel itself.

In a study published in December 2018 in The Journal of Hand Surgery, researchers used dynamic ultrasound to capture images of longitudinal median nerve motion inside the tunnel as compressive forces were applied to the two sides of the wrist and distal forearm in both healthy and CTS patients. The researchers observed that the median nerve moved more within the carpal tunnel in patients with CTS compared to those without the condition.

In an anatomical study published in the journal Clinical Biomechanics (November 2018), lead author Dr. Elena Bueno-Gracia and colleagues measured the cross-sectional area of the carpal tunnel before and after manual manipulation and mobilization of the carpal bones. They observed both an increase in the front-to-back diameter of the tunnel AND a reduction in pressure on the median nerve. Additionally, the researchers noted that the shape of the carpal tunnel itself becomes more round following manipulative therapy. The research team reported that their findings are consistent with prior studies.

These studies demonstrate that the carpal tunnel is indeed dynamic/flexible and that manual techniques can alter its shape, providing more “breathing room” and allowing the contents within (i.e., the tendons and the median nerve) increased mobility with less friction.

Doctors of chiropractic are trained to provide manual therapies, which include mobilization and manipulation, of the spine and extremities of individuals with musculoskeletal conditions, including carpal tunnel syndrome.  Together with the “standard” therapies previously mentioned, proper exercises, and patient education, chiropractic is the perfect choice for non-surgical CTS care!

 

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.

Do Splints Help Carpal Tunnel Syndrome?

11 Feb

Carpal tunnel syndrome (CTS) is a very common condition caused by inflammation of the median nerve that runs through the palm side of the wrist. When the median nerve is pinched and irritated, numbness, tingling, and/or weakness in the hand can result.

Wrist splinting is a common recommendation given to CTS patients by all healthcare providers, including chiropractors, based on the theory that pressure increases dramatically inside the tunnel at the extremes of wrist bending, so restricting motion may allow the associated soft tissues to become less inflamed. But, does splinting actually work?

One study that included 36 participants looked at the outcomes of night-time splinting only, using a common thermoplastic neutral wrist splint. The researchers observed that the patients in the study reported improvements related to their hand/wrist symptoms at the three-month point, while after six months, the participants had also experienced improvements related to wrist function.

To determine if all splints and braces for CTS were the same or if some were better than others, a 2018 study compared the efficacy of a neutral wrist splint vs. one the incorporated a “lumbrical unit” that extended further into the hand. After six weeks, patients in both groups reported improvements related to pinch and grip strength, but the patients given the longer splint also experience statistically significant improvements related to pain and function.

What about combining nerve and tendon stretching exercises WITH wrist splinting? One study that included 51 mild-moderate CTS patients found that those who performed nerve/tendon gliding exercises (three times a day for four weeks) reported better outcomes regardless of which splint they used. A similar study found that patients who engaged in a home stretching program and who wore the longer splint were less likely to require surgical intervention.

These studies support the use of a longer splint and stretching exercises in the management of CTS. When treating patients with CTS, doctors of chiropractic typically take a multimodal approach that includes wrist splinting, specific exercises/stretches, and manual therapies in order to reduce pain and improve function in the wrist and surrounding tissues.

 

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 a Job Cause Carpal Tunnel Syndrome?

7 Jan

Every career has its pros and cons when it comes to physical exertion, stress, work hours, the physical environment (temperature, cleanliness, etc.), and more. But when a worker develops carpal tunnel syndrome (CTS), is it the job that’s the culprit or is there something else responsible for the patient’s symptoms?

Since we spend about a third of our time each week at work, it only makes sense that certain jobs are more likely to cause or exacerbate CTS. The current research shows that jobs that include the following factors have an elevated risk for repetitive stress injuries, like CTS: highly repetitive tasks; exposure to vibratory/percussive forces; and little-to-no down time or rest breaks.

Examples of careers associated with such factors include auto repair, landscaping, garment work, computer work, dental hygiene, hair dressing, music, retail, radiology, meatpacking, massage therapy, and carpentry, just to name a few.

One’s risk for developing the symptoms associated with CTS can also be raised by factors outside of work such as having conditions like diabetes, hypothyroid, obesity, and arthritis (rheumatoid and osteoarthritis, most commonly); hormonal changes associated with birth control pills and pregnancy; and musculoskeletal dysfunction elsewhere along the course of the carpal tunnel. If someone who may already have an increased risk for CTS takes on a vocation that requires repetitive and forceful movements with few breaks, then the chances they develop pain, tingling, and numbness in their hands and wrists may be even higher.

The good news is that in many cases, a worker can recover from CTS and return to their job of choice (that is, not have to change careers) with reasonable work modifications (better ergonomics, more breaks, changes to the tools used), better management of health conditions associated with increased CTS risk, night splinting, dietary modifications to reduce inflammation and promote healing, and conservative care to address any musculoskeletal issues that are present (of which chiropractic care is a fantastic choice).

 

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.