Carpal tunnel syndrome (CTS) is a common problem. It has been reported that the frequency of the problem in the United States occurs in up to 150 cases per 1000 people per year. There are some occupations where the incidence of CTS could be even higher per 1000 people. The frequency in Great Britain has been reported to be between 70-150 cases per 1000 people. The occurrence has been cited as low as 2-3 per 1000 in Holland. Carpal tunnel is almost unheard of in underdeveloped countries.
The median nerve is made up of a group of smaller nerves that begins at the mid to lower neck. The nerve passes down into the shoulder, arm and around the elbow. From there it passes down the forearm into the wrist. It is here that the nerve passes beneath the transverse ligament. The median nerve supplies the thumb, index and middle finger.
The consequence of not having this condition treated is that it can result in permanent damage to the median nerve. This article outlines how non-surgical care may be successful in the care of carpal tunnel syndrome.
What are the Symptoms of Carpal Tunnel?
Carpal tunnel needs to be differentiated from a pinched nerve in the neck, shoulder or elbow. Description alone of the symptoms is not enough for a diagnosis; an examination of the neck, shoulder, elbow and wrist is also necessary. The condition is more prevalent in Caucasian women with an age range from 40-60 years old. Carpal tunnel occurs less frequently in women under the age of 30 . Pregnant women and diabetics have a higher prevalence of carpal tunnel problems. Some common symptoms include:
- Numbness and Tingling in the Thumb, Index and Middle Fingers
- Fingers and Hand May Feel Swollen
- Sleep Disrupted with Pain and Numbness
- Difficulty Holding or Gripping Objects
- “Needles and Pins” Sensation
- Weakness in the Hand
- Forearm Pain
- Possible Muscle Atrophy at the Base of the Thumb
History of onset as well as a regional examination are necessary to arrive at the diagnosis.
What Causes Carpal Tunnel Syndrome?
The debate rages as to the cause of carpal tunnel. The onset of the problem isn’t always that clear. Listed below are some potential contributing factors. These include:
- Repetitive Activity – Carpenters, mechanics or any work or recreational activity that requires repetitive hand motion
- Poor Office Ergonomics – Computer work with poor keyboard placement and work place design
- Hormonal Changes – Pregnancy, menopause and thyroid disease commonly affect the carpal tunnel.
- Sprains, Fractures and Dislocation
- Rheumatoid and Osteoarthritis
- Diabetes
How is Carpal Tunnel Diagnosed?
A history will be taken to discover the onset, frequency of symptoms and those positions, postures or activities that make the complaints worse.
Examinations vary from physical tests and observations to electrical studies done by a neurologist or clinician qualified to perform and interpret the results. Arriving at the proper diagnosis includes exclusion as well as inclusion. X-rays may be of little value.
Conservative Management of Carpal Tunnel
What conservative measures can be used to treat carpal tunnel? Incorporation of various office and home treatments has been successful in many cases. The combined use of these modalities offers a better result than the use of a single treatment. These measures may include:
- Chiropractic Adjustments to the Wrist – To regain movement of the bones of the wrist and improve joint mobility.
- Brace For Nighttime Splinting – Protects the wrist from flexing which can compress the carpal tunnel while sleeping. The brace may be needed early in the treatment until there is an improvement of the symptoms. This is not only protective, it aids in the resolution by preventing aggravations.
- Ergonomic Changes to the Work Place – Change the height of the work table to placement for the “90/90 posture“.
- Ice Massage – Helps to reduce swelling and control pain.
- Stretching Exercises – These should be done before work and throughout the workday
- Modify Activities of Daily Living – Avoid actions and routines that aggravate the wrist and increase symptoms. Many times this involves trial and error. “If it hurts, don’t do it”.
- Nutrition and Nutricuticals – The B vitamins such as B6 have been found to be of help. Omega 3 fatty acids, a natural anti-inflammatory, is also useful. Bromelain found in pineapple is another natural anti-inflammatory.
- Manual Therapy – Graston technique or instrument myofascial release of the soft tissue around the carpal tunnel.
Food rich in anti-oxidants can also be helpful. These foods include:
- Berries – Blueberries, strawberries, raspberries, blackberries and cranberries
- Grapes – Red grapes and red wine
- Chocolate – Dark chocolate in moderation is the only chocolate that qualifies
- Artichokes – Artichoke hearts
- Potatoes – Baked and sweet
- Apples – Red delicious are the highest in anti-oxidants
- Carrots – The easy snack food that is loaded with beta carotene
- Red Beans – Also a benefit as they are high in fiber
- Nuts – Walnuts, pecans and hazelnuts
Avoiding surgery is the logical first step. If conservative treatment is not successful, surgery may be the only option. Mayo Clinic has stated that about 5% of patients will experience a return of carpal tunnel symptoms after surgery. This article does not take into consideration other complications of surgery.
The doctors at Coon Rapids Chiropractic Office have experience in the conservative care and management of carpal tunnel syndrome.