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Carpal Tunnel Syndrome (CTS)
Authors: Greg Millar, DC CCEP; Ken Randolph, DC; and Justin Walbom, DC;
Carpal Tunnel Syndrome (CTS) has become one of the most widespread occupational health problems we face today. It affects millions of people a year, and with our growing reliance on computers there seems to be no end in sight. As a Chiropractor we see this condition almost daily in our clinics.The syndrome is caused by entrapment or pressure on the median nerve just above the wrist in the carpal tunnel. The pathophysiology is not completely understood but can be considered compression of the median nerve traveling through the carpal tunnel..
Pressure on this nerve can be caused by an injury, repetitive or sustained use, or from common activities like typing, chopping, hammering, or pushing (over use syndrome). It can even be caused or made worse by sleeping with your hand bent at the wrist, often tucked up under your neck, body, or chin. Symptoms of CTS range from wrist pain, numbness, tingling, burning, weakness or loss of grip strength, and loss of sleep due to discomfort. The most common symptom of CTS is numbness and or tingling to the thumb and first two fingers. People often report that they have lost grip strength in the affected hand. This is usually noticed when trying to pick up a cup of coffee. Weakness and atrophy of the thenar muscles may occur if the condition remains untreated.. If the symptoms involve just the last two fingers it is often misdiagnosed as CTS but is actually something just at treatable (ulnar nerve entrapment).
Most cases of CTS are of unknown causes, or idiopathic. There is lots of debate in medical circles about work related CTS. The Occupational Safety and Health Administration (OSHA) has adopted rules and regulations regarding cumulative trauma disorders. Occupational risk factors of repetitive tasks, force, posture, and vibration have been cited. Carpal Tunnel Syndrome can be associated with any condition that causes pressure on the median nerve at the wrist. Some common conditions that can lead to CTS include trauma, work related activities, arthritis, diabetes, obesity, oral contraceptives, sleep posture, and hypothyroidism. Carpal tunnel can also be associated with a form of Charcot-Marie-Tooth syndrome Type 1. Other causes of this condition may include lesions that exert pressure within or outside the carpal tunnel, and include benign tumors such as lipomas, ganglion, and even some vascular malformations.
Clinical diagnosis is made by taking a history and performing a physical examination. Common test used include:
Phalen's Test is performed by flexing the wrist gently as far as possible, then holding this position and awaiting symptoms. This non specific test is often used by clinicians as a quick diagnositc tool. A positive test is one that results in numbness in the median nerve distribution when holding the wrist in acute flexion position within 60 seconds. The quicker the numbness starts, the more advanced the condition. Phalen's sign is defined as pain and/or paresthesias in the median-innervated fingers with one minute of wrist flexion.
Tinel's sign, a classic — though non specific - test is a way to detect irritated nerves. Tinel's is performed by lightly tapping or rapping the skin over the wrist (flexor retinaculum) to reproduce the tingling sensation or "pins and needles" in the median nerve distribution. A positive Tinel's sign (pain and/or paresthesias of the thumb, first and second finger with tapping over the median nerve) is more specific than Phalen’s sign.
Durkan test, carpal compression test, or applys a firm pressure to the palm over the nerve for up to 30 seconds to trying to elicit carpal tunnel type symptoms.
Other conditions may also be misdiagnosed as carpal tunnel syndrome. Thus, if history and physical examination suggest CTS, patients will sometimes be tested electrodiagnostically with nerve conduction volicity (NCV) studies and electromyography. The goal of electrodiagnostic testing is to compare the speed of conduction in the median nerve with known normals and also compare the conduction speed of other nerves supplying the hand.
There are a number of different ways to treat CTS. In most cases, a chiropractic adjustment to the affected area is an extremely effective solution. In some cases, a misalignment in the neck and upper back (C5-T1) can cause this condition, and chiropractic manipulation of the neck and/or spine can also serve as an effective treatment option. These treatments, along with Therapeutic exercise, stretching, and strengthening exercises, and physical modality treatments such as e-stim, ultra sound, and cold laser treatments can in most cases effectively alleviate the symptoms associated with CTS. Some cases require us to tape the hand into a position re-approximating the carpal tunnel. The patient is then asked to perform exercises in this taped position.
In severe cases we often work in conjunction with our Medical Doctors doing steroid injections into the carpal area. We like to use the steroid approach sparingly due to the effects of the steroid on the body. Some cases however do require surgery. If surgery is required we highly recommend a hand surgeon or a hand fellowship trained orthopedic specialist as opposed to a general orthopedist. For our patients that do have surgery we highly recommend the Endoscopic technique vs the open surgery. Endoscopic techniques or endoscopic carpal tunnel release involve one or two smaller incisions (less than half inch each) through which instrumentation is introduced and used to visualize the underside of the transverse carpal ligament. A prospective randomized study done in 2002 by Trumble revealed that good clinical outcomes and patient satisfaction are achieved more quickly with the endoscopic method.
For home remedies as a Chiropractor we recommend the use of a cock-up splint that can be purchased at most any drug store or mass retailer. We have found a nice home remedy for the end of the day. Take a dixie cup fill it 1/2 full of water and freeze it. Then tear off the paper around the ice and apply directly to the wrist area. We also recommend soaking the wrist in warm salt baths. We like the use of the anti-inflammatory Boswellin. (check with your healthcare professional before taking and don't use if you have stomach issues or problems).
1. Scott, Kevin R.; Kothari, Milind J. (October 5, 2009). "Treatment of carpal tunnel syndrome."
2. Lazaro, R (1997). "Neuropathic symptoms and musculoskeletal pain in carpal tunnel syndrome: Prognostic and therapeutic implications". Surgical Neurology 47 (2): 115–7; discussion 117–9.
3. Sternbach, G (1999). "The carpal tunnel syndrome". Journal of Emergency Medicine 17 (3): 519–23.
At Millar Chiropractic Clinic, Dr Greg Millar DC CCEP (Certified Chiropractic Extremity Probationer) treats Carpal Tunnel Syndrome (CTS) and its non surgical treatments. We use all the latest equipment including traction and laser treatments. Call today for a free consultation appointment.