The purpose of this article is to help you identify the signs and symptoms, who is at risk, causes, treatment options and the risks of surgical intervention.
Carpal Tunnel Syndrome (CTS) is a median nerve neuropathy that causes paresthesia (abnormal sensation), pain, numbness, and other symptoms along the distribution of the median nerve.
The median nerve branches off of the spinal cord in the neck and travels down through the shoulder, arm, wrist, hand and into the fingers as part of the brachial plexus.[flashvideo file=http://lifechiropractic.s3.amazonaws.com/05.14.2013.carpal.tunnel.bi-1.mp4 image=https://lifechiropracticcentre.ca/wp-content/uploads/2013/05/carpal.tunnel.syndrome.jpg width=500 height=299 /]
The brachial plexus is a group of nerves branching off of the spinal cord in the neck and upper back which is primarily responsible for controlling the entire upper limb (arm).
The carpal tunnel exists where the wrist joins the hand and the median nerve passes through this tunnel into the hand and fingers. This is one location where the median nerve can become trapped but there are several other key areas where entrapment can occur with or without entrapment in the wrist.
The main symptom of CTS is intermittent numbness of the thumb, index , middle and half of the ring finger on the thumb side.
The numbness often occurs at night and can peak during the early hours of the morning with tingling and sometimes pain especially on the thumb side of the hand, including the thumb. The small finger is always excluded. CTS is often times worse in the dominant hand but can affect both. The pain usually spreads upwards into the forearm. Pain in CTS is primarily numbness that can be so intense, it will wake sufferers from their sleep.
Associated symptoms may include pain in the wrists or hands which can come and go (intermittent), and loss of grip strength. It has been my clinical experience that loss of grip strength can be one of the very first symptoms patients may experience even before onset of the more characteristic symptoms.
Dropping things such as coffee cups and difficulty loosening or tightening the lids on jars are definite signs that grip strength is weakening. In fact, if this condition is left untreated there is the risk of further weakness and wasting of the thumb muscles. So, early diagnosis and treatment is paramount to preventing permanent nerve damage.
CTS is typically found in people who perform repetitive daily tasks with their fingers or hands such as keyboarding (computer), video games, texting (cell phones), cashiers, assembly-line workers and individuals using hand tools especially vibrating tools. There are some conditions that can lead to or precipitate CTS symptoms such as obesity, oral contraceptives, pregnancy (fluid retention),hypothyroidism, arthritis, diabetes, impaired glucose tolerance (pre-diabetes), physical trauma (spine, collar-bone and/or wrist) and prior carpal tunnel syndrome surgery. It has been my clinical experience however that a pre-existing problem is often times present and these conditions are usually not the primary cause.
I would qualify them as ‘aggravating factors.’
Of course the more serious conditions need to be ruled out and treated if present as these are a far greater risk to the patient than pain and numbness in the fingers. These being hypothyroidism, arthritis (rheumatoid especially),diabetes and pre-diabetes. Tumors such as a ganglion or lipoma (both benign) can protrude into the carpal tunnel, but these are exceedingly rare (less than 1%).
We will focus mostly on the neurological causes of CTS because there is invariably a neurological component to all cases, and in my experience addressing the neurological component yields the best results.
The median nerve can be impinged at the following levels: at the spinal cord level in the neck, at the nerve root level in the neck, between the 1st rib and the collar bone, in between tight muscles along the front of the neck (scalene muscles), between 2 heads of a tight muscle in the forearm and in the carpal tunnel itself (carpal bones). Misalignment (subluxation) of the neck vertebrae, the collar bone, 1st rib and carpal bones will cause a boney irritation to the median nerve.
Soft –tissue irritation occurs where the muscles become tight in the neck and forearm. A Double-Crush Syndrome occurs when the nerve is irritated in 2 places, usually the spine, its articulations (1st rib especially) and the carpal tunnel itself.
So how do these things happen?
Repetitive Strain Injuries ( refer to; Who gets CTS? above) can affect the spine, skeletal joints, extremity joints and certain muscles as previously noted. Consistent stressful forces (strain) over time will cause physical misalignment of spinal, skeletal and extremity joints. Consistent stressful forces will also cause muscular hyper-tonicity (tightness).
But we must not discount trauma. Whiplash injuries to the neck (car accidents, hard falls and sporting injuries, for example) can have a direct effect on spinal alignment, 1st rib alignment, collar bone alignment and the muscles along the front of the neck (scalene muscles).
The carpal bones can easily be misaligned when heavily grasping the steering wheel in preparation for a head-on collision. CTS is often times the result. Falls onto an outstretched arm (diving to catch a baseball or football) or trying to break a fall with ones hand can cause structural and soft-tissue (muscle) damage in the wrist and forearm (possibly even fractures) as well as the aforementioned structures. A rebound effect can travel up the arm through the collar bone, the 1st rib and into the neck itself especially with hard falls onto the hands and wrists (trying to break your fall on an icy sidewalk, for example).
CTS is often times the result.
Medical treatments are restricted to medication (painkillers/muscle-relaxers/anti-inflammatories), splints, corticosteroid injections and physiotherapy (low-grade results) but these offer temporary relief of symptoms at best. ‘Carpal tunnel release surgery’ is recommended in extreme cases when conservative treatment is of no benefit. Other considerations are the side-effects associated with all medications and the risks associated with surgery (bleeding, infection, nerve damage).
This is what I have found to work the best when it comes to treating CTS: correction (chiropractic adjustment) of structural misalignments wherever they exist along the course of the median nerve. This includes the cervical (neck) vertebrae, the first rib, the collar-bone and the tiny carpal bones in the wrist. This will in effect decompress the impinged nerve; in other words the degree of physical irritation will be reduced if not entirely eliminated and symptoms will begin to resolve.
Soft-tissue therapy is recommended if the typical muscles are involved which the patient can easily learn to do at home with proper instruction. This includes stretching, mobilization exercises, postural exercises, trigger point release therapy and ice-massage. These are most effective when complimenting chiropractic (spinal) care. Of course, any ergonomic issues would also need to be addressed to help minimize further repetitive strain if this was indeed the underlying cause.
The reason why chiropractic treatments can have such a huge impact on CTS is because it addresses the causative factors, not just the effects (symptoms). Remember that even though the effects are uncomfortable and what motivate you to seek treatment, they are not the problem. The problem is where the physical impingement exists along the path of the median nerve. The effects will resolve on their own when the causative factors have been reduced or eliminated.
So, if you or anyone you know is suffering from CTS, I would like to offer you an appointment for a free initial consultation to find out more about how we can help.
Our phone number is 905 335 LIFE (5433) and we have office hours on Mondays, Wednesdays, Thursdays and most Saturday mornings.
Please call us today.