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Carpal Tunnel Syndrome

Dr. Christa S. Andreoli, DC, DACO, MCS-P

Adapted from Caitlin Lukacs; Published in the May 2014 ACA News; acatoday.org

Carpal Tunnel Syndrome (CTS) is often associated with prolonged computer use, but it can also affect construction workers, assembly-line workers and even athletes — any person who does a lot of gripping or holding the wrist in an unnatural position. Women are three times as likely to develop CTS as men.

What is carpal tunnel syndrome?
CTS is an irritation to the median nerve as it passes through the wrist. Flexor tendons become swollen from overuse, and occupy more space in the carpal tunnel, which in turn compresses the nerve.

Symptoms
CTS most often appears as numbness in the thumb and first two fingers. But symptoms can include burning, tingling, itching, weakness and/or numbness in the palm of the hand, thumb and fingers. Some sufferers of CTS describe their fingers as “useless and swollen,” even if no swelling is apparent. Weakened grip strength often makes it hard for CTS patients to form a fist or grasp small objects. Additionally, many CTS patients report that it is hard to distinguish hot from cold by touch. The symptoms of CTS generally first appear while sleeping because many people have a tendency to sleep with flexed wrists.

Diagnosis
A CTS diagnosis is 95-percent personal history. History and physical examination of the hands, arms, shoulders and neck, is often all that is needed for a diagnosis. There are, however, specific tests that can be done to reproduce the symptoms of CTS and confirm the diagnosis.

• Laboratory tests and imaging studies. These tests can reveal diabetes, arthritis, fractures and other common causes of wrist and hand pain, helping to rule out CTS. Electrodiagnostic tests, such as nerve conduction velocity testing, can be used to help confirm the diagnosis of CTS. With these tests, small electrodes, placed on your skin, measure the speed at which electrical impulses travel across your wrist. CTS will slow the speed of the impulses.

There are many other conditions that mimic the symptoms of carpal tunnel syndrome, including a pinched nerve in the neck. CTS may be related other health conditions that causes swelling, such as hypothyroidism, diabetes, inflammatory arthritis, over-activity of the pituitary gland,  mechanical problems in the wrist joint, poor work ergonomics, repeated use of vibrating hand tools and fluid retention during pregnancy or menopause.

Treatment
The best treatment for CTS is to use manipulation, therapy and exercise of the wrist. It may be helpful to do gentle adjustments of the spine. Sometimes a carpal tunnel splint may be applied to the wrist.

A research study, “Comparative Efficacy of Conservative Medical and Chiropractic Treatments for Carpal Tunnel Syndrome: A Randomized Clinical Trial,”1 utilized the chiropractic treatments of ultrasound, nighttime wrist supports and manipulation of the wrist, arm and spine. These techniques were compared with the conventional model of Ibuprofen plus a night wrist splint. While both groups had similar results, the potential side effects of Ibuprofen on the stomach, liver and kidneys led the authors to conclude that a strong argument can be made for the non-drug, chiropractic approach.

Cold lasers or other physiotherapy may be considered, and surgery as a last resort for resistant cases.  Because carpal tunnel syndrome can stem from poor workplace ergonomics or improper posture, some patients are more susceptible to CTS after they’ve experienced it once, especially if they do not make improvements in posture.

Conservative treatment generally has good results in most cases, and is tried before invasive treatment is considered.

References:
1. Davis PT, Hulbert JR, Kassak KM, et al. “Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trial.” J Manipulative Physiol Ther. 21.5 (June 1997): 317-326.

2. Brantingham JW, Cassa TK, Bonnefin D, Pribicevic M, Robb A, Pollard H, et al. Manipulative and multimodal therapy for upper extremity and temporomandibular disorders: a systematic review. J Manipulative Physiol Ther. Elsevier; 2013 Mar;36(3):143-201.

3. Burke J, Buchberger DJ, Carey-Loghmani MT, Dougherty PE, Greco DS, Dishman JD. A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. J Manipulative Physiol Ther. 2007 Jan;30(1):50-61.