Pain Relief Chiropractic

The wrist is very flexible, and the reason the wrist is so supple is because it’s made up of eight small carpal bones that are lined up in two rows of four bones each. Along with the transverse carpal ligament, these rows of carpal bones form an actual tunnel in which nine muscle tendons (and their sheaths) and the median nerve pass. If inflammation or swelling occurs that reduces the space in the carpal tunnel, then the median nerve can become compressed and restricted, which stimulates the various symptoms commonly linked to carpal tunnel syndrome (CTS). Another factor that can limit space in the carpal tunnel has to do with hand positions.

In a 2023 study, researcher utilized high-frequency, diagnostic ultrasound (HFDU) to specifically look at median nerve position changes and cross-sectional area of the nerve when the wrist is bent upward (dorsiflexion) and downward (palmar flexion) in 85 patients (110 affected hands) diagnosed with mild (n=38), moderate (n=30) and severe (n=42) CTS as well as 25 healthy control subjects (50 hands). Compared with the control wrists, the CTS-affected wrists exhibited much greater median nerve compression against the floor of the tunnel (the transverse carpal ligament) in both bent wrist positions. The researchers also used a diagnostic technology called nerve conduction velocity to confirm that this compression at the end-ranges of wrist flexion and extension are associated with dysfunction of the median nerve.

While this finding is interesting, it just reinforces what many healthcare providers already know about CTS: symptoms worsen at the end ranges of motion, and prolonged, awkward wrist postures should be avoided. That’s why one of the most common tools used to manage CTS is a nocturnal wrist splint to prevent the wrist from bending during sleep. However, it’s generally not recommended to wear a wrist splint at all times as immobilization could lead to deconditioning of the muscles in the region and worsen the patient’s situation.

In addition to avoiding prolonged bending of the wrists, CTS patients are also instructed to try to keep the wrist in a neutral position, take frequent breaks, and avoid high vibration exposure when performing hands-on work or hobby-related tasks because it can increase inflammation in the carpal tunnel and exacerbate symptoms and slow recovery. 

Successful management of CTS may also involve addressing non-musculoskeletal factors that can promote inflammation or swelling in the wrist, such as diabetes. Patients may also receive advice on inflammation-promoting foods to avoid or supplements to take to reduce inflammation in the body. Your chiropractor will also assess the full course of the median nerve starting at the neck to make sure there are no other areas in which the nerve’s motion is restricted since it’s not uncommon for this to occur in multiple sites.  

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

Tags: carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is a condition the occurs when mobility of the median nerve is restricted as it passes through the wrist, resulting in symptoms that extend into parts of the hand including pain, numbness, tingling, and weakness. Generally, symptoms come on gradually but worsen and become more frequent over time. While most often associated with computer work, CTS can affect anyone whose work involves repetitive hand movements—especially when combined with non-neutral wrist postures or vibration exposure—or who is affected by conditions that create swelling or inflammation in the wrist tissues, such as pregnancy, obesity, diabetes, rheumatoid arthritis, and more. There are many treatment options available to the CTS patient, of which chiropractic care is highly favored both by patients and the clinical treatment guidelines.

When the CTS patient first presents for chiropractic treatment, they will complete a patient history that describes both their current symptoms as well as any other health conditions they’ve had in the past or are currently experiencing. In addition to letting the doctor of chiropractic know if there are health conditions that may contribute to CTS and may require co-treatment to achieve a successful resolution, the history will also indicate the potential for conditions that can co-occur with CTS or be mistaken for it, such as median nerve compression elsewhere along the course of the median nerve or compression of another nerve that innervates other parts of the hand, such as the ulnar nerve. With this information, the chiropractor will conduct an examination to better understand the patient’s unique situation, which may include diagnostic imaging, such as X-ray. At this point, they can confirm a diagnosis and decide upon a treatment approach.

Treatment will typically include a combination of in-office therapies and at-home instruction. In-office treatment will primarily involve manual therapies, such as manipulation, mobilization, and soft tissue work, to increase mobility of the median nerve as it passes through the wrist as well as elsewhere along the course of the nerve’s course if multiple entrapments are present. In-office treatment may also include modalities such as cold laser, e-stim, pulsed electromagnetic field, and more. 

Between visits, patients may be advised to wear a wrist splint at night or during some activities, though not all the time, to help keep the wrist in a neutral position that takes pressure off the median nerve. They may also be instructed on exercises or stretches they can perform several times a day and/or receive instruction to take supplements or modify their diet to reduce inflammation. 

While several studies support these conservative treatment approaches for managing CTS, it’s important to note they work best early in the course of the disease. The longer a patient waits to seek care, the more time it may take to achieve a satisfactory outcome. In severe cases, the only option may be surgical intervention. If you’re currently dealing with bothersome symptoms in the hand and wrist, don’t just shake your hand and carry on. Contact your doctor of chiropractic and schedule an evaluation. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

Tags: carpal tunnel syndrome

Outside of an emergency situation, such as a wrist fracture, treatment guidelines for carpal tunnel syndrome generally recommend exhausting non-surgical options before consulting with a surgeon. But how well are guidelines followed? To find out, researchers surveyed 770 members of the American Society for Surgery of the Hand to better understand the current practice patterns regarding the non-surgical care for CTS patients. Roughly half of respondents had two decades or more of experience in the field with 80% completing a residency in orthopedic surgery and 81% either currently have or previously had a subspecialty in hand surgery.

According to the survey, 72.9% of the CTS patients the surgeons consulted with had previously had two or more corticosteroid injections with 41.2% of surgeons recommending an additional injection before recommending surgery. About four-in-five surgeons did not believe oral steroids are effective for managing CTS though they are included in clinical treatment guidelines developed by the American Academy of Orthopedic Surgery (AAOS). The authors of the study note there is a lack of feedback to the patient’s primary care doctor (and other authorities) when these approaches fail, which may perpetuate their use unnecessarily. 

The researchers point out that the current AAOS clinical treatment guidelines cite strong evidence to support corticosteroid injections and moderate evidence that oral steroids could improve patient-reported outcomes compared to placebo. The study authors continue by noting a study that found corticosteroid injections may only provide short-term benefits compared to a placebo, and another study that concluded a second corticosteroid injections may not offer additional benefit. 

The survey results appear to be contrary to the guidelines put forth by the AAOS, which may be misguiding primary care and general orthopedic physicians. The authors conclude that their findings highlight the importance of better implementation of non-surgical CTS treatment strategies that follow current evidence-based information, rather than following the clinical practice guidelines of the AAOS.

The good news is that the various treatments provided by doctors of chiropractic are highly effective in managing mild-to-moderate CTS as studies have demonstrated that such conservative therapies can be as effective as surgery over the long-term with fewer adverse events. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

Tags: carpal tunnel syndrome

Carpal tunnel syndrome (CTS) can be a complex condition that can be a challenge to manage for several reasons.

• There can be multiple contributing causes. Seldom is CTS the result of one traumatic event, like a broken wrist that produces instant symptoms that requires emergency surgical treatment. Rather, the condition tends to develop over time as the result of an accumulation of microtraumas that affect the tissues in the carpal tunnel and place pressure on the median nerve and hamper its mobility. To complicate matters even more, conditions like hypothyroidism, pregnancy, obesity, and the use of birth control pills can also affect the function of the median nerve, either directly or indirectly through swelling/inflammation.
• Median nerve entrapment elsewhere. The median nerve originates in the cervical spine and travels from the neck to the shoulder and down the arm. Compression anywhere along the path of the nerve can stimulate CTS-like symptoms. Additionally, entrapment of the median nerve elsewhere on its course can often co-occur with entrapment at the wrist.
• It might not be carpal tunnel syndrome. While we commonly associate symptoms in the hand and fingers with CTS, there are two additional nerves—the radial and ulnar—that innervate other parts of the hand and fingers. Radial and ulnar nerve entrapment can also co-occur with CTS.
• Work can be the cause. Occupational exposure to vibration, repetitive movements, infrequent breaks, and awkward wrist postures can each increase the risk for CTS. It may not be possible for the patient to change how they perform their work, which can make recovery difficult. 
• Some factors can’t be controlled. Women are three times more likely to develop CTS than men, which is believed to be due to females having a narrower carpal tunnel and possibly hormonal differences compared with males. The risk for CTS also increases with age. 
• Patients often wait too long. Because CTS symptoms come on gradually, it’s easy to ignore them, and a patient may not seek care until their symptoms become so bothersome or severe that they simply can’t maintain their usual activities. Unfortunately, the longer a patient waits, the longer it may take to achieve a satisfactory resolution. In some cases, a full resolution may not be possible or surgery may be the only viable option. 

The good news is that chiropractic care can be an effective intervention for managing CTS, especially if you seek care sooner rather than later. If necessary, your doctor of chiropractic will co-manage the case with an allied healthcare provider to give you the best possible chance at recovery.

Pain Relief Chiropractic

4909 Louise Dr

Mecanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

Tags: carpal tunnel syndrome

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.

Tags: carpal tunnel syndrome

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.

Tags: carpal tunnel syndrome