Tag Archives: carpal tunnel syndrome

Carpal Tunnel Syndrome – More Facts!

4 Jan

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.


Carpal Tunnel Syndrome – Are There Other Tunnels?

31 Dec

Carpal Tunnel Syndrome (CTS) refers to the median nerve being pinched in a tunnel at the wrist. As the name implies, “carpal” refers to the 8 small bones in the wrist that make up the “U” shaped part of the tunnel and “syndrome” means symptoms that are specific and unique to this condition. As we learned last month, CTS can be affected by nerve pinches more proximal to the wrist, such as at the forearm, elbow, mid-upper arm, shoulder or neck. To make matters more complex, there are two other nerves in the arm that can also be pinched in different tunnels, and the symptoms of numbing and tingling in the arm and hand occur with those conditions as well. This is why a careful clinical history, examination, and sometimes special tests like an EMG/NCV (electromyogram/nerve conduction velocity) offer the information that allows for an accurate diagnosis of one or more of these “tunnel syndromes” in the “CTS” patient. Let’s look at these different tunnels and their associated symptoms, as this will help you understand the ways we can differentiate between these various syndromes or conditions.

Let’s start at the neck. There are seven cervical vertebrae and eight cervical spinal nerves that exit the spine through a small hole called the IVF (intervertebral foramen). Each nerve, like a wire to a light, goes specifically to a known location which includes: the head (nerves C1, 2, 3), the neck and shoulders (C4, 5), the thumb side of the arm (C6), the middle hand and finger (C7) and the pinky side of the lower arm and hand (C8). If a nerve gets pinched at the spinal level (such as a herniated disk in the neck), usually there is numbness, tingling, and/or pain and sometimes, usually a little later, weakness in the affected part/s of the arm and hand (or numbness in the scalp if it’s a C1-3 nerve pinch). So, we as chiropractors can test the patient’s sensation using light touch, pin prick, vibration, and/or 2-points brought progressively closer together until 1-point is perceived and then comparing it to the other arm/hand. Reflexes and muscle strength are also tested to see if the motor part of the nerve is involved in the pinch. The exam includes compression tests of the neck to see if the arm “lights up” with symptoms during the test.

Next is the shoulder. Here, the nerves and blood vessels travel through an opening between the collar bone, 1st rib and the chest muscles (Pectorals). As you might think, the nerves and blood vessels can be stretched and pinched as they travel through this opening and can cause “thoracic outlet syndrome.” Symptoms occur when we raise the arm overhead. Hence, our tests include checking the pulse at the wrist to see if it reduces or lessens in intensity as we raise the arm over the head. At the shoulder, the ulnar nerve is the most commonly pinched nerve, which will make the pinky side of the arm and hand numb, tingly, and/or painful. A less common place to pinch the nerves is along humerus bone (upper arm) by a bony process and ligament that is usually not there or resulting from a fracture. Here, an x-ray will show the problem.

The elbow is the MOST common place to trap the ulnar nerve in the “cubital tunnel” located at the inner elbow near the “funny bone” which we have all bumped more than once. Cubital tunnel syndrome affects the pinky side of the hand from the elbow down. The median/carpal tunnel nerve can get trapped here by the pronator teres muscle, thus “pronator tunnel syndrome.” This COMMONLY accompanies CTS and MUST be treated to obtain good results with CTS patients. The radial nerve can be trapped at the radial tunnel located on the outside of the elbow and creates thumb side and back of the hand numbness/tingling.

Hence, you see the importance of evaluating and treating ALL the tunnels when CTS is present so a thorough job is done (which is what Chiropractors do). Try the LEAST invasive approach first – non-surgical treatment – as it’s usually all that is needed!

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 – 13 Fun Facts!

24 Dec

Carpal Tunnel Syndrome (CTS) results in numbness, tingling, and sometimes weak grip strength due pinching of the median nerve as it travels through the carpal tunnel at the wrist. There are many conditions that are similar to CTS, many of which we have discussed in the past. The following is a list of “13 fun facts” aimed at helping to properly identify CTS, knowing what to do about it, and at helping to make an informed decision as to whom to seek help for it.

CTS is most common in women, age >50, who work in a repetitive, rapid moving manually demanding occupation (typing/computer work, line assembly work, waiting tables, and more).

CTS is complicated by the presence of obesity, diabetes, hypothyroid, pregnancy, taking birth control pills, and other conditions that cause inflammation (rheumatoid arthritis and others).

CTS may develop on the dominant side, the non-dominant side or both– each case is individual.

CTS symptoms may FIRST present as morning or night time numbness that can wake the sufferer up once or many times during the night.

CTS sufferers USUALLY wait for weeks, months or even years before seeking help for it, which is a risk factor for a delayed recovery – GET HELP ASAP!!!

CTS can often be managed without surgery– especially IF you have it treated sooner rather than later.

CTS surgery may be necessary if non-surgical care fails. This may be due to the nerve being damaged beyond a certain point (an EMG/NCV or, electromyography/nerve conduction velocity helps determine this along with an accurate history and examination).

CTS non-surgical care includes: chiropractic manipulation of the wrist, elbow, shoulder and/or neck– depending on the case. All health care providers usually include a night wrist splint, anti-inflammatory measures, ergonomic modifications of work stations, and stretching exercises.

CTS non-surgical success favors chiropractic because of the inclusion of the manual therapies. When only exercise, night splinting, and NSAIDS are used, the success rate drops off dramatically.

Reduced thyroid function makes CTS worse because of the unique type of swelling associated with hypothyroidism called “myxedema.” Because of the confined space available in the carpal tunnel, a small amount of swelling can result in nerve compression and the classic numbness/tingling symptoms in the middle three fingers on the palm-side of the hand.

CTS is worse at night because it is impossible to control the position of the wrist while we sleep. As a result, we tend to curl the wrist and hand under our chin, and when the wrist bends forwards or backwards, the pressure inside the carpal tunnel increases significantly due to the change in tunnel size. This is why wearing a wrist splint at night REALLY HELPS as it keeps the wrist from bending, keeping the tunnel as wide as possible, thus lowering the pressure within it.

CTS patients respond well in some cases to vitamin B6. This is due to the healing effects of B6 (peridoxine) on neuropathy and/or it’s anti-inflammatory qualities. Other anti-inflammatory nutrients include ginger, turmeric, boswellia, bioflavinoids, white willow bark, quercetin, and others.

CTS patients do not always improve after surgery. This can be due to the fact that the median nerve is frequently “pinched” in more than one area such as the neck, thoracic outlet (shoulder), pronator tunnel (elbow) as well as at the wrist. When more than one compression is present, this is referred to as “double” or “multiple crush syndrome.”

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 – What Makes My Hands Numb?

16 Dec

Carpal Tunnel Syndrome (CTS) sufferers frequently report a cluster of symptoms, but almost all have one symptom in common – numbness, usually in digits 2-4 on palm-side of the hand. CTS is usually attributed to an over-use type of injury such as repetitive work including (but not limited to): typing, assembly work, packaging jobs, machine operators, and many more. Last month, we discussed CTS “Facts” and learned many important points about CTS. This month’s focus centers around the common question, “….where is this numbness coming from?”

To answer this, let’s review the anatomy: The carpal tunnel is made up of 8 small “carpal bones” that form an arch or tunnel, and the base of the tunnel is formed from the transverse carpal ligament. There are nine tendons that attach muscles in the forearm to each finger and work when we grip or form a fist with our hand. Wiggle your fingers and look at your wrist and forearm – do you see all the activity or movement going on?

The tendons travel through sheaths which help lubricate the sliding tendons. When we move our fingers fast (such as typing, playing piano, performing assembly work, etc.), friction and heat builds up, resulting in swelling. If adequate rest does not occur, the increased pressure from the swollen tendons end up squeezing all the contents within the tunnel, which includes the median nerve. It’s the median nerve pinch that results in the numbness, tingling, and/or pain into the index, third and forth fingers.

There are other conditions that can either complicate or cause CTS. These include: hypothyroid disease (due to myxedema), diabetes (due to neuropathy), inflammatory arthritis (of which there are several kinds – rheumatoid is the most common), and pinching of the nerve either in the neck, shoulder, elbow or forearm (called double or multiple crush syndrome).

The reason chiropractic helps so much is that we can alleviate the pressure on the nerve from the neck down to the wrist and restore nerve function. This alleviates the multiple sleep interruptions, weakness in the grip that is so common, as well as helping to restore the nerve’s function. Many studies support the success of chiropractic and CTS – try it first as surgery should be the last resort.

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.

Nutritional Post-Surgical Management of CTS.

14 Dec

Obviously, the goal of all health care providers, including chiropractic management of Carpal Tunnel Syndrome (CTS), is to AVOID surgical intervention, but this is not always possible. Last time, we looked at herbal approaches to reduce inflammation with the focused goal of preventing surgical need. But, as chiropractors, we also care for patients post CTS surgery, and one of our treatment approaches beyond manual therapies includes nutritional management.

As we all know, during the surgical process, tissue damage occurs due to incisions, removal of injured tissue, and other factors. Depending on the “success” of the surgical procedure, damage to the nerves causing numbness, weakness, and/or other nerve related symptoms can occur. Often, nerves will regenerate during the healing process but not always 100%. This may be due to factors such as the amount of tissue damaged during the surgery, the length of time CTS had been present pre-surgery, how well the patient follows post-surgical instructions, as well as the general health and overall condition of the patient. A healthy diet along with certain specific vitamins can play a positive role in tissue healing and nerve regeneration. Here are some examples:

Folate or vitamin B9 has been reported to have beneficial effects on the genes located within the nerve cells that help to regulate the healing process. One study published in 2010 reported that folate helped to promote nerve repair in the central nervous system (CNS) in rats, which is unique as typically nerve damage in the CNS does not usually regenerate. Anti-inflammatory benefits have also been reported with vitamins B6, B9, and B12.

Cobalamin or Vitamin B12 has also been reported to facilitate nerve regeneration after injury. This, along with the anti-inflammatory benefits, supports the use of B12 in the post-surgical CTS patient.

Vitamin D may also play a significant role in nerve regeneration after surgery. In one study, vitamin D2 was found to have a positive effect on nerve regeneration. Another study reported that D3 and calcium together has strong anti-inflammatory benefits.

Vitamin B6: There is evidence that supports the use of B6 both before and after surgery. Some feel B6 acts directly on nerve repair and others report a diuretic (fluid reducing) benefit. One cause and/or complication of CTS is fluid retention, which commonly occurs in conditions such as pregnancy, the use of birth control pills, obesity, diabetes, and others. Thus, keeping fluids in our tissues under control can certainly help CTS patients. Most studies agree that less than 200mg of B6 per day is safe. The dosage should be carefully monitored as numbness/tingling (a common CTS symptom) can be a sign of B6 toxicity.

Vitamin C has long been reported to facilitate in the wound healing process. It also is an effective anti-inflammatory agent, a common problem in the cause of CTS as well as a negative post-surgical side effect. A dose of 1000-3000mg/day spread out throughout the day is beneficial to the post-surgical healing process.

Vitamin E: As far back as 1967, Vitamin E been reported to reduce inflammation. More recent studies report that when used in combination with vitamin C, the two together works even better in reducing inflammation than either one alone. Also, this combination was found to improve the body’s ability to use insulin, which may also facilitate healing in the post-surgical CTS patient.

There are many others we didn’t get to (such as B1, 3, 5; zinc, Bromelain, and Quercetin). Bottom line: Eat healthy, exercise, don’t smoke, and fortify your diet with these nutrients!

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 & Herbs.

14 Dec

Carpal Tunnel Syndrome (CTS) is a condition caused by the compression of the median nerve as it travels through the carpal tunnel in the wrist. The “source” of median nerve compression can be soft tissue swelling, such as tendonitis, bursitis, synovitis, capsulitis, etc. Last month, we discussed nutritional supplementation for CTS in general. This month, the focus is on specific herbs that can help this potentially disabling condition.

Chamomile functions as a natural “tranquilizer.” It’s used for muscle pain (as a relaxant), but can also help other problems such as menstrual disorders, headaches, and tension. Chamomile facilitates relaxation of tight muscles and has an anti-inflammatory property that soothes cramps.

Kava Root is an herbal plant that is well known for its muscle relaxing benefits. It is particularly helpful with extreme muscle pain.

Valerian is a very effective relaxant that dates back to the medieval times for curing ailments associated with muscle spasms such as muscle cramps and neck problems.

Catnip is also a natural muscle relaxant, and is a member of the mint family. It is used as a sedative and muscle relaxer. Headaches due to tension have been treated using a poultice containing catnip. Catnip has also been found to reduce swelling in joints and reduce soft tissue injuries such as tendonitis, bursitis, and capsulitis.

Cayenne Pepper is a popular herb used in cooking and can be found in many recipes. Cayenne pepper has been found to significantly relieve the pain of muscle cramping.

Horseradish has been reported to relieve extreme muscular stress involved in cramps and muscle pain. One approach is mixing a few drops of horseradish oil in bath water to reduce soreness associated with muscle aches.

Lavender flower oil is well known as a very effective muscle relaxant that provides relief caused by muscular tension. Using a circular motion while massaging the oil over the achy muscle can be particularly soothing. In addition to the mind/body relaxation benefits, an increase in circulation allows the tense muscles to relax and heal.

Licorice has the ability to reduce inflammation associated with muscle pain.

Devil’s Claw is a very popular anti-inflammatory herb that dates back to the 18th century for the treatment of arthritis and many other painful conditions. It’s also used as an effective muscle relaxer.

Peppermint oil has been used to treat conditions associated with muscles aches. Pouring some drops of peppermint oil in a hot bucket of water to soak a foot, ankle or lower leg (possibly combined with Epson salt) can be very relieving.

Other natural muscle relaxants include Cramp bark, Passiflora, Bergamot, Cardamom, Basil, Ginger root, and others.

It is appropriate to COMBINE these natural herbal approaches with other treatments that are known to work well in the treatment of CTS. Chiropractic can provide: 1. Manipulation and mobilization of the neck, shoulder, elbow forearm, wrist, hand, and fingers; 2. Cock-up splints to be worn at night and at times during the day such as driving; 3. Physical therapy modalities such as electric stim, ultrasound, light or laser therapy, magnetic field; 4. Work station and other ergonomic modification recommendations; 5. Exercise training, 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.