Pain Relief Chiropractic

WHAT is Carpal Tunnel Syndrome (CTS)? CTS occurs when pressure is applied to the median nerve which travels from the neck, through the shoulder, upper arm, elbow, forearm, and through the carpal tunnel where the “pinch” is located. The median nerve innervates most of the palm of the hand, the thumb, the index finger, middle finger, and the thumb side of the ring finger. The carpal tunnel is made up of eight little bones in the wrist that form the arch and a ligament that forms the floor. There are nine muscle tendons, the median nerve, as well as blood vessels that travel through the tunnel.

WHAT are the symptoms of CTS? The “classic” symptoms include burning, itching, tingling, and/or numbness of the second to fourth fingers with the need to shake or “flick” the fingers to “wake up the hand.” When present long enough, or when the pressure is hard enough on the nerve, weakness in the grip occurs and accidental dropping of tools, coffee cups, and so on can occur. Pressure on the nerve increases when the wrist is bent backwards or forwards, especially for long time frames and/or when the wrist is moving in a fast, repetitive manner with jobs like carpentry using vibrating tools, a screw driver, hand drill, a hammer, line production work, waitressing, and so on. Often, symptoms are first noticed at night, as we tend to sleep with our wrists bent and tucked under our chin or neck. Symptoms can also occur during the day, especially when driving or when performing repetitive work. Difficulties buttoning a shirt, making a fist, grasping small objects and/or performing manual tasks are common complaints of CTS.

WHAT are some causes of CTS? CTS is most commonly caused by a combination of factors that result in swelling of the tendons that travel through the carpal tunnel. This includes over working the arm and hand in any of the jobs described above, but it is more likely to happen when conditions that create generalized swelling occur. Some of these conditions include trauma (like a sprained wrist), hypothyroidism, an over-active pituitary gland, during menstruation or pregnancy, menopause, rheumatoid arthritis, diabetes, mechanical wrist problems, repetitious work (work stress), or the repeated use of vibratory hand tools. It is also possible to develop a cyst (like a ganglion) or a fatty tumor within the tunnel. CTS is also more common with obesity, but sometimes, no logical cause can be identified!

WHO is at risk of developing CTS? Women are three to four times more likely to develop CTS. This may be because of the hormonal aspects described above and/or the relative smaller wrist, which results in a smaller carpal tunnel. There’s also an increased risk of CTS in people over the age of 50. Other at risk individuals include diabetics, people with hormonal imbalances (taking birth control pills, pregnancy, hypothyroid, etc.), and people who work on assembly lines.

How is CTS diagnosed? EARLY diagnosis and treatment is KEY to a successful outcome! The physical exam includes assessing the structures of the neck and entire upper extremity, as the pinch is often in more than one place. A blood test for thyroid disease, diabetes, and rheumatoid arthritis is also practical. Other tests that may help us diagnose CTS can include and EMG (nerve test) and/or x-ray/MRI. Next month, we’ll discuss treatment and prevention!

Tags: carpal tunnel syndrome, mechanicsburg pa chiropractor

Carpal Tunnel Syndrome (CTS) is technically a “pinched nerve” in the wrist (carpal tunnel) that results in numbness, tingling and later, weakness in the distribution of the median nerve (thumb, index, 3rd, and half of the 4th finger). There is a limited amount of space within the carpal tunnel. In addition to the median nerve, there are 9 tendons and their sheaths, a network of blood vessels, the joint capsules, the bony “roof” and ligamentous “floor.” Any condition that distorts the shape of the tunnel  (inflammatory conditions like rheumatoid arthritis, ganglion cysts, bony spurs, or conditions that result in swelling like overuse, pregnancy, taking birth control pills, hypothyroid, obesity, and/or conditions that create neuropathy like a pinched nerve in the neck, shoulder or elbow, diabetes and post-chemotherapy) can result in median nerve irritation. The carpal tunnel naturally changes its shape when we flex and extend the wrist, so occupations that require wrist bending (especially if it’s prolonged and a fast pace is required) such as carpentry (especially the use of vibrating tools), waitressing, assembly line work, typists, and even sleeping at night with the wrist bent can result in CTS.

The diagnosis can be tricky because of all the possible causes (of which, some are described above) and to make matters even more challenging, there can be two, three, or more of the causes all contributing to the problem at the same time! In the clinic, there are certain positions to test how long (in seconds) it takes for the numbness, tingling and/or pain to occur when we place the wrist in extreme flexion or extension. We’ll compress the carpal tunnel (and nerve pathways at the elbow, shoulder, and neck), as well as tap over the carpal tunnel with a reflex hammer creating a “funny bone” sensation usually into the 2nd or 3rd finger. Blood tests for rheumatoid (and other inflammatory) arthritis, diabetes and thyroid dysfunction are very helpful when trying to differentiate between several possible causes. An electrical conduction test called electromyogram (EMG) and nerve conduction velocity (NCV) can also be very helpful in determining the severity of CTS.

So the question is, can you “self-diagnose” CTS? The answer is: sometimes. However, with that said, if the symptoms are “classic” (numbness/tingling in the thumb, fingers 2-4, which shaking and flicking your fingers relieves at least partially; it’s waking you up at night especially, if a night splint helps reduce the frequency of waking and intensity of numbness), then you “probably” have CTS. Here are some common questions included in a CTS questionnaire that we often use in the clinic to assist with the diagnosis: SYMPTOM SEVERITY (score each on a 0-4 scale): 1) Pain severity at night? 2) Nighttime frequency of waking with pain? 3) Amount of daytime hand/wrist pain? 4) Frequency of daytime hand/wrist pain? 5) Duration (in minutes) of daytime pain/numbness? 6) Severity of numbness? 7) Severity of weakness? 8) Tingling intensity? 9) Nighttime severity of numbness or tingling? 10) Nighttime frequency of numbness or tingling? 11) Difficulty grasping / using small objects like keys or pens? FUNCTION SEVERITY (0-4 scale): 1) Writing. 2) Buttoning clothes. 3) Holding a book while reading. 4. Gripping of a telephone handle. 5) Opening jars. 6. Household chores. 7. Carrying grocery bags. 8. Bathing and dressing. The maximum score for SYMPTOM SEVERITY is 11×4 = 44 and for FUNCTION 8×4 = 32. To determine the percentage, divide your score by 76 (the maximum possible) and multiply it by 100. In general, scores >50% may be indicative of CTS. However, as previously stated, a definitive diagnosis must include a detailed history, examination, sometimes special tests. Therefore, it is important to see us! If you have CTS, we will outline the type and length of care with you and MOST IMPORTANT, we can usually manage CTS without the need for surgery!

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