Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

What is it?

Carpal Tunnel Syndrome (CTS) occurs when a nerve on the palm side of the wrist is pinched. It is named after the area of the wrist from where the symptoms occur. The Carpal Tunnel is basically a horseshoe shape made from 8 small carpal bones and the ends of the horseshoe are connected with a ligament thus completing the “tunnel.”

What are the symptoms?

CTS symptoms include pain from swelling of the tendons inside the CT. When the nerve pinch occurs, numbness, tingling, or a half asleep sensation into the 2 nd , 3 rd , and 4 th fingers occurs. This is often worse at night due to the wrist being bent when asleep. This often wakes the person and shaking/flicking the hand/fingers is needed to “wake them up.” Grip weakness is also associated with CTS such as difficulty opening jars.

What are the causes?

Usually, over use from tasks including repetitive line work (meat/fish/poultry packing, cookie/food packing), typing, sewing, carpentry, waiting tables, and the like. Other “contributors” include hormone related conditions such as hypothyroid, dysmenorrhea, diabetes, and obesity. These fast/repetitive movements cause swelling of the tunnel’s contents (9 tendons and the median nerve) and the nerve is pushed into the ligament connecting the ends of the horseshoe/tunnel.

Who is at risk?

Gender is a significant factor as women are 3x more likely to develop CTS than men as the CT may be smaller in woman. The dominant hand is often first affected and more severe. Hormone imbalances as described above also increase risk.

How is it diagnosed?

The history of the symptoms as well as physical examination of the hands, arms, shoulders and neck can lead to the proper diagnosis. The exam consists of trying to reproduce the numbness into the fingers by pressing/holding over the CT and other areas where the nerve runs down the arm (including the neck where the nerve originates), tapping over the CT with a reflex hammer, bending and holding the wrists at the extreme endpoints of motion. Also, poking the skin with a sharp object and comparing the 2 nd to 4 th fingers to other parts of the hand and the opposite side commonly yields differences between the two sides. Questionnaires and hand diagrams completed by the patient are helpful and quantify the degree of severity. Tests used during the course of treatment help track improvements. More sophisticated testing includes an EMG (nerve conduction test) that tests the motor and sensory changes when the nerve is pinched.

How is it treated?

Chiropractic approaches include manipulation of the wrist, hand, forearm, shoulder and neck, specifically addressing the areas of greatest restricted motion. Soft tissue therapy includes massage, active release, graston, trigger point, and a host of physical therapy modalities such as light/low level laser, IFC, ultrasound, microcurrent, and low frequency approaches. Exercise training to be repeated multiple times per day is very helpful. Wrist bracing especially at night is also a common treatment approach used by all health care providers. Nutritional counseling and supplementation is also very helpful.

How can it be prevented?

Work station assessments, staying in shape (avoid obesity), taking “minibreaks” when doing repetitive work, and proper treatment for conditions like hypothyroid, diabetes, and other disorders associated with CTS.