Health Update: Carpal Tunnel
Carpal Tunnel Syndrome (CTS) – Can It Be Prevented?
Carpal Tunnel Syndrome is a very common problem affecting many workers and is one of the most costly conditions afflicting today’s workforce. It is most often caused by repetitive activity using rapid movements of the arms and hands and can lead to work loss and disability when not properly managed. Carpal Tunnel Syndrome occurs when the median nerve that travels through the carpal tunnel located on the palm side of the wrist becomes pinched by the swelling of the 9 tendons that also travel through the carpal tunnel and essentially, pinch the nerve up against the transverse carpal ligament. This results in numbness, tingling and/or pain of the index, middle and forth fingers.
Other symptoms include sleep interruptions where shaking and flicking of the fingers is required to allow for a return to sleep. This is frequently caused by sleeping with the wrist in a cocked position, increasing the pressure inside the already swollen carpal tunnel. This is why a cock-up wrist splint usually helps as it disallows the wrist from bending to the extremes and the nerve is not pressured or pinched as much. Other symptoms include weakness of the grip, making it a challenge to unscrew a jar, open a door, and even sometimes turn the key when starting a car. Driving can also be affected as the hands often fall asleep while holding onto a steering wheel.
Pain can also affect the rest of the arm and sometimes the neck area. The median nerve can also be pinched in more than one place and may include the neck, shoulder, elbow as well as the wrist making it necessary to have all the areas treated for a satisfying result.
People at greatest risk are women more than men, workers who handle small tools, computer workers, fast repetitive line workers, and people older than 40 years of age. People with other health conditions including rheumatoid arthritis, Lymes disease, rubella, pregnancy, birth control pill use, diabetes mellitus and menopause are at an increased risk of developing Carpal Tunnel Syndrome. Certain foods such as caffeine, tobacco, and/or alcohol may also contribute to Carpal Tunnel Syndrome.
Though treatment is very important –the sooner the better- prevention is most important. In fact, some simple approaches can make a big difference! Some of these include modifying the position of a computer chair, keyboard, monitor, or mouse (work station modifications), alternate between different tasks to reduce the repetition of work, stretch your forearms and fingers before, during and after work, and treat any underlying conditions. When symptoms first occur, these recommendations, as well as wearing a night wrist cock-up splint and seeing your chiropractor, will often reverse the condition without difficulty. If you wait too long and nerve damage occurs, it becomes a more challenging process to manage Carpal Tunnel Syndrome and at times, even surgery will not be very helpful.
Some of the non-surgical treatment approaches you might expect from your chiropractor include joint manipulation and/or mobilization applied to the neck, wrist, elbow and/or shoulder, the application of physical therapy modalities such as ultrasound, electrical stim, and/or low level laser therapy (“light” therapy), as well as the use of wrist splints.
The University of Maryland Medical Center cites two research articles on chiropractic treatment for Carpal Tunnel Syndrome. They report good results are usually obtained and that these good results continued for at least 6 months after treatment ended. The same reference also recommends nutrition and supplements in the management of Carpal Tunnel Syndrome. Some of these include: eliminate food allergens (often milk, cheese, eggs, ice cream, glutens/wheat-grains, soy, corn, and preservatives) and eating foods high in B-vitamins (dark leafy greens like spinach, kale, and sea vegetables), anti-oxidants (fruits – blueberries, cherries, tomatoes; vegetables – squash, bell peppers), using olive oil and adding omega 3 fatty acids to the diet (fish oil), and avoiding refined foods. Other vitamins including a multivitamin, B complex, Vit. C, alpha-lipoic acid, MSM, resveratrol, Vit. D, Co-Q10, magnesium can also really help.
We realize that you have a choice in where you choose for your healthcare services. If you, a friend or family member requires care for Carpal Tunnel Syndrome, chiropractic care is a logical first choice and we would be honored to offer our services to you.
Health Update: Carpal Tunnel
Carpal Tunnel Syndrome
What Are My Options?
Carpal Tunnel Syndrome has been reported to be the most expensive of all work-related injuries, costing the average Carpal Tunnel Syndrome patient about $30,000 in medical bills and lost work time over his or her lifetime. Carpal Tunnel Syndrome is primarily found in adults, is 3x more frequently found in women, and usually affects the dominant hand first. The pain can be quite severe and disabling. Certain occupations tend to cause Carpal Tunnel Syndrome more than others, such as manual labor jobs (assembly-line / manufacturing, sewing, finishing, cleaning, meatpacking, food processing and packing occupations). Other jobs like computer work, playing a musical instrument and waitressing can also cause Carpal Tunnel Syndrome. Certain medical conditions such as diabetes, obesity, pregnancy, the use of birth control pills, inflammatory arthritis and hypothyroidism can predispose patients to Carpal Tunnel Syndrome. Carpal Tunnel Syndrome is caused by a pinch to the median nerve that runs down the arm from the neck, through shoulder, elbow and wrist. The pinch can occur in one or more of these locations making it important to obtain a complete evaluation including the neck and upper arm – not just the wrist. There are a total of 9 tendons, ligaments, and blood vessels jammed into the tight confines of the carpal tunnel formed by 8 small carpal bones and the transverse carpal ligament that serves as the “roof” of the tunnel. Symptoms include burning, tingling, aching, and/or numbness primarily into the 2nd to 4th fingers and at times, the thumb. Some sufferers develop weakness in their grip making it hard to open jars, stubborn door knobs, holding onto a newspaper or steering wheel. Waking up multiple times at night is also a common complaint caused by sleeping with the wrist bent, which increases the pressure inside the tunnel, thus pinching the nerve more firmly.
A Carpal Tunnel Syndrome diagnosis is made by reproducing the symptoms by further compressing the median nerve inside the tunnel. This is accomplished by applying pressure over the tunnel, by bending the patient’s wrists 90 degrees backwards (dorsiflexion) and forwards (palmar flexion), compression over the proximal forearm, at the thoracic outlet (under the collar bone) and / or at the neck. Special tests like an EMG/NCV (electromyogram and nerve conduction velocity) can determine the degree of nerve damage and verify the diagnosis. At times, x-ray or MRI are helpful if arthritis or a bone spur is suspect, or to measure the size of the carpal tunnel. Laboratory blood tests to determine secondary causes, described earlier, can also be of benefit.
Treatment consists of 1. Rest; 2. Modifying the activity or workstation suspected of causing Carpal Tunnel Syndrome; 3. Using a splint- especially at night and when driving; and 4. Managing any underlying disease condition. Managing inflammation is also important, which can be accomplished by the use of ice. (Ice massage is very effective. This consists of freezing water in paper cups, tearing off the top half of the cup, and rubbing the ice against the skin for approximately 5 minutes. The sequence of sensations includes cold, burning, aching, and numbness (“C-BAN”). Make sure you quit when numbness is reached, as frost bite is a risk if performed for too long.) Anti-inflammatory medications like ibuprofen, naproxen, or herbal remedies such as ginger, turmeric, boswellia, and/or vitamins like bromelain and papain, vitamin B6, fish oil (omega 3 fatty acids), vitamin D (2000-5000IU), and calcium/magnesium are all potentially helpful. Manual manipulations to the joints of the neck, shoulder, elbow, wrist and hand, and soft tissue manipulation to the muscles and tendons of the forearm and hand can also be used. Other non-surgical treatments include exercises and physical therapy modalities such as low level laser therapy, electrical stimulation, ultrasound, and others.
We realize you have a choice in where you choose for your healthcare services. If you, a friend or family member requires care for Carpal Tunnel Syndrome, chiropractic care is a logical first choice and we would be honored to offer our services to you.
To schedule a FREE Consultation with Dr. Falkenroth, simply call (831) 475-8600
Health Update: Carpal Tunnel
Carpal Tunnel Syndrome – A “Typical” Case Example
“I’ve been working on the line for 13 years and started noticing periodic tingling in my fingers. It didn’t last long and I didn’t think about it much. It gradually became more frequent and wouldn’t go away when I changed my activity or shook my hand or fingers. It started to really grab my attention when I started to drop things out of my hand and couldn’t open jars as easily. That’s when I decided to see what was wrong. I didn’t know who to go to so I went to my family doctor and he diagnosed carpal tunnel syndrome. He gave me a splint to wear at night and some anti-inflammatory drugs that irritated my stomach, so I quit the drugs. The splint helped me sleep and I didn’t wake up as often. The doctor was talking about surgery to un-pinch the nerve at my wrist if it didn’t get better soon, but I overheard some co-workers talk about seeing a chiropractor for their carpal tunnel problems and how much better they felt, so I decided to try it.
“The chiropractor was very thorough and examined my neck, shoulder and elbow, as well as my wrist and hand. He indicated that several areas were putting pressure on the nerve that goes into the hand and the pinch was not just at the wrist but higher up in my neck, shoulder and forearm. He said if I wasn’t at least 50% better in 4 weeks, we would talk about other tests and treatment options and investigate it further. He worked on my neck, shoulder, elbow, forearm and hand, using manipulations and other methods to loosen it up. He said the nerve was getting pinched by the muscles working too fast and not getting enough rest. He gave me exercises to do several times a day at work to stretch the forearm muscles and had me continue the use of the brace at night. He also taught me how to ice massage the wrist for 5 minutes until it got numb, several times a day and he recommended I use vitamin B6, 50mg, three times a day. After the 3rd week, I started to notice a decrease in the intensity, frequency and duration of numbness and weakness. He said he may have to evaluate my workstation and make some modifications, if possible. He asked me a lot about the position of my wrist and hand when I work and didn’t seem to like the type of screw driver I was using. He called my boss and asked if a different type of screw driver with a power source and a pistol shaped handle could be tried and it was arranged. That seemed to really make a difference.”
Carpal Tunnel Syndrome is a common problem that is usually cumulative, slow and gradual in its onset, and can progress to a point where functions like buttoning shirts, threading a needle, and holding a newspaper are greatly affected. People usually don’t run to the doctor at the first signs of Carpal Tunnel Syndrome, as the initial symptoms are vague and initially not too impairing. Over time, Carpal Tunnel Syndrome can become quite severe and often prompts a surgical recommendation.
There are a number of studies published regarding the chiropractic management of Carpal Tunnel Syndrome that show non-surgical methods that can be quite successful. One compared medical care consisting of non-steroidal anti-inflammatory drugs and nocturnal wrist splinting to chiropractic care consisting of spine and extremity manipulation, nocturnal wrist splinting, and ultrasound over the wrist. Both treatment approaches were helpful, suggesting the importance of trying either or even both of these non-surgical treatments prior to proceeding to surgery.
If you, a friend or family member requires care for Carpal Tunnel Syndrome, we would be honored to have the opportunity to help.
Health Update: Carpal Tunnel
Carpal Tunnel Syndrome – What Else Could It Be?
In our clinic, we see patients frequently with Carpal Tunnel Syndrome. It is a very common condition and usually responds well to Pro-Adjuster treatments of the hand, wrist, elbow, shoulder and/or neck.
Carpal Tunnel Syndrome symptoms include numbness, tingling, or half asleep sensations in the hand involving the palm and 2nd, 3rd, and thumb side of the 4th fingers. Sometimes, there is weakness in the grip strength with frequent dropping of objects or difficulty unscrewing jars commonly reported. Waking at night and needing to shake or flick the fingers to “…wake them up” is common. Driving due to holding onto the steering wheel with the wrist bent, holding a book or newspaper, buttoning a shirt, and threading a needle, can all become challenging when the median nerve which goes through the carpal tunnel is pinched. Because there are 9 tendons along with the median nerve that travel through the tunnel, fast repetitive movements of the hands and fingers is frequently associated with the onset of Carpal Tunnel Syndrome. What makes treatment of Carpal Tunnel Syndrome challenging is that most patients wait WAY TOO LONG before they seek help and nerve damage can occur as a result.
So, what happens when Carpal Tunnel Syndrome does not respond to non-surgical treatment? Also, what can be done if, after Carpal Tunnel Syndrome surgery, problems still persist? The answer to these questions rests in obtaining a thorough evaluation of the condition including a detailed history and examination and, consideration of a different or concurrent condition. For example, from an anatomy standpoint, a pinched nerve in the neck, thoracic outlet (shoulder) and/or elbow (pronator tunnel syndrome), may be the primary issue, not Carpal Tunnel Syndrome alone or, sometimes at all. If BOTH Carpal Tunnel Syndrome and a pinched nerve above the wrist are present, the “double or multiple crush syndrome” must be addressed in order for a successful and satisfying outcome to occur.
Another nerve called the ulnar nerve can create numbness and weakness in the hand and can be confused with Carpal Tunnel Syndrome. Because only about 50% of patients with hand numbness can accurately report the location of the symptoms, diagnosing compression of the ulnar nerve is essential as a Carpal Tunnel Syndrome release will NOT help those with ulnar neuropathy. The most common location for pinching the ulnar nerve is at the inner or medial elbow near the “funny bone,” referred to as the cubital tunnel. It can also be compressed at the wrist, neck, or combinations of these resulting in a double or multiple crush syndrome. We’ve had many patients present with “carpal tunnel” that were not Carpal Tunnel Syndrome at all but rather, ulnar nerve compression conditions.
Therefore, when considering treatment options for Carpal Tunnel Syndrome and/or other nerve compression syndromes affecting the upper limb, it is imperative that a thorough evaluation of the presenting patient be performed so time is not wasted treating an unrelated condition and to obtain a satisfying outcome. If you, a friend or a family member requires care for Carpal Tunnel Syndrome, Pro-Adjuster treatments on the neck, shoulder, elbow, wrist or hand may help.
To schedule a FREE Consultation with Dr. Falkenroth, simply call (831) 475-8600.
Carpal Tunnel Syndrome – Exercise Options
There are many exercise options for Carpal Tunnel Syndrome. This is because Carpal Tunnel Syndrome is a “cumulative trauma” condition where repetitive motion results in overuse and subsequent injury to multiple areas in the upper extremities. Most exercises address the forearm, wrist and hand as well as the neck, shoulder, and elbow, depending on the extent of the cumulative injury. Since each case of Carpal Tunnel Syndrome is unique and individually different from other cases, it is smart to start with basic exercises and add more exercises over time rather than to begin too many exercises at once.
Because Carpal Tunnel Syndrome is caused most frequently from overusing the hands over time such as a repetitive job or hobby, stretching the inflamed tendons (the string-like attachments of muscles to the bone) is an important objective. There are 4 basic movements of the wrist and the muscles that move the wrist and fingers are located in the forearm and hand. Hence, stretching will take place in these four different directions as overuse injuries or tendonitis is usually not limited only to the carpal tunnel tendons (located on the palm side of the wrist), but usually includes many of the other muscle/tendons on the thumb and/or back side of the wrist. The following are 3 exercises that stretch the wrist/hand on the thumb side, back side, and palm side.
Exercise 1 (for the thumb side of the wrist): START POSITION: Sit or stand with both arms held out straight (elbows, wrists & fingers), thumbs pointing upwards & palms facing each other. MOVEMENT 1: Tuck the thumb into the each palm and grab it with the other 4 fingers making a fist with the thumb inside the fist. MOVEMENT 2: Bend the wrist downwards towards the ground and feel the stretch on the top/thumb side in the wrist and thumb. Hold for 8-10 seconds and repeat many times a day (example once an hour).
Exercise 2 (for the back side of the wrist): START POSITION: Same as above. MOVEMENT 1: Bend (flex) the fingers at the big knuckles (base of the fingers) followed by flexing the wrist. MOVEMENT 2: Using your other hand, pull the back of the hand and apply a gradually increasing stretch until a “good hurt” is achieved on the back side of the forearm, wrist and hand. Hold for 8-10 seconds and repeat many times a day (example once an hour).
Exercise 3 (for the palm side of the wrist): START POSITION: Same as above. MOVEMENT 1: With the fingers pointing downwards, place the palm of the hand on the wall or hook the fingers on the edge of a desk or table’s edge and apply a gradual increasing stretch by bending the hooked fingers backwards until the “good hurt” is felt in the forearm palm-side muscles. MOVEMENT 2: Reach over the top with your other hand and grasp your thumb and pull back adding an additional stretch to the tendons that travel through the carpal tunnel. Hold for 8-10 seconds and repeat many times a day (example once an hour).
Done together, these 3 exercises, performed multiple times a day, (especially during work or at times of fast, repetitive arm/hand movements) can act as a “mini-break” from the fast, repetitive work. At our office, we incorporate mobilization of the joints that may relieve carpal tunnel symptoms including the neck, shoulder, elbow, forearm, wrist and hand, depending on what is needed for each case. Wrist splinting, especially at night, nutritional advice, workstation assessments, also play important roles in the non-surgical care of Carpal Tunnel Syndrome. We appreciate the opportunity to help you, your family, friends or co-workers who are suffering from Carpal Tunnel Syndrome. Remember – try this approach first, BEFORE surgery, as this approach carries less risk and, it is frequently all that is needed!
Carpal Tunnel Syndrome – Common Issues
You are driving down the road and you notice numbness and tingling in your fingers. You find temporary help by shaking and flicking the fingers, trying to “wake them up.” You’ve also noticed your sleep is becoming interrupted and the need to shake and flick the fingers in the middle of the night is becoming more frequent. If this sounds like you or someone you know, you’re not alone. This condition affects many workers as well as “stay-at-home moms,” as women are 3 times more likely to develop Carpal Tunnel Syndrome due in part because the carpal tunnel itself is smaller than those in men. Also, women tend to work faster in fast, repetitive jobs, and are often hired specifically for that reason. Further, when workers are paid by the number of pieces they produce, the tendency is to try complete as many pieces as possible so as to make that much more over their base hourly wage.
Basically, Carpal Tunnel Syndrome is caused by pressure building up in a small confined space through which a nerve (the median nerve) and 9 tendons converge into this tight opening into the hand. When repetitive work/fast movements are performed over hours at a time and day after day, the friction produced by the tendons rubbing against each other results in heat, swelling, pain, and median nerve pinching which produces the classic symptom of tingling/numbness into the 2nd, 3rd and half of the 4th fingers. Hence, those at greatest risk for developing Carpal Tunnel Syndrome include line workers such as manufacturing, sewing, finishing, cleaning, and fish and/or meat packing. In 1998, 3 of every 10,000 workers lost work time due to Carpal Tunnel Syndrome of which half missed more than 10 days of work. Considering the increased amount in today’s dollars of medical and disability costs, the average lifetime cost of Carpal Tunnel Syndrome was estimated at $30,000 for each worker back in 1998.
So, how do you know if you have Carpal Tunnel Syndrome? The early signs include occasional numbness or tingling in the fingers that you probably wouldn’t think much about since simply shaking your hand or flicking your fingers make it go away. As the numbness becomes more frequent and it does not respond by shaking and flicking the fingers as quickly, you might take notice. Without proper management, difficulty buttoning shirts/cuffs, writing, holding onto small objects, opening jars, all become gradually more pronounced. When sleep becomes interrupted, especially when it becomes necessary to get up and move around before being able to return to sleep, that’s when people usually decide, “I better see someone for this!”
Treatment success is directly related to how fast a person reacts by making a prompt appointment. The best results always occur when care is obtained quickly, when the initial symptoms first appear. In addition, there are sometimes underlying contributors or causes such as diabetes, arthritis, pregnancy, birth control pill use, hypothyroid, obesity, and other conditions that may need proper management in order to relieve the symptoms. Non-surgical care includes the use of wrist splints (especially at night when sleeping), anti-inflammatory measures (medications, gluten-free/paleo diet, vitamin B6 and others such as omega 3 fatty acids/fish oil, vitamin D3 in high doses, calcium, magnesium, CoQ10), work station modifications, forearm exercises, chiropractic treatment of the neck and arm, acupuncture, and certain modalities such as low level laser/light therapy, can all be helpful.
Surgery should always be considered a “last resort” after all non-surgical approaches have been exhausted. Rarely is there a “medical emergency” that warrants prompt surgical release except in cases of fracture where the carpal tunnel canal is abruptly reduced in size. You need a “quarterback” to help guide you in the treatment/management process. Dr. Falkenroth is well trained to manage Carpal Tunnel Syndrome and offer a non-drug, non-surgical solution to this potentially disabling condition.
To schedule a FREE Consultation with Dr. Falkenroth, simply call (831) 475-8600.
