NJ Carpal Tunnel Syndrome Info

Why Should I Exercise For Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome (CTS) is an EXTREMELY common condition that can affect anyone at any age. In fact, there’s a strong probability that up to 50% of the people reading this today have or have had symptoms of CTS at some point in time and 10% or more have been treated for it! We have recently discussed various non-surgical treatment approaches for managing CTS but the question of WHY exercises should be included in that program remains a mystery to many!

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Why Nighttime Pain with Carpal Tunnel Syndrome?

Chiropractors are often asked, “Why does Carpal Tunnel Syndrome (CTS) bother me so much during the night?” Let’s take a look!

The carpal tunnel is made up of eight small carpal bones that bridge the forearm to the hand. Without these eight little bones, the motion at the wrist would be very restricted and limited to bending a little bit up and a little bit down. Think of all the things you are able to do with a large range of motion at the wrist like tightening a small screw by hand, pulling on a wrench, using a hammer, working under the dash or inside the engine compartment of a car, threading a needle, sewing, knitting, crocheting, and even washing dishes. As you can see, we put our wrists in some pretty strange positions!

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Carpal Tunnel Syndrome During Pregnancy

While Carpal Tunnel Syndrome (CTS) is usually characterized as a repetitive stress injury, it can also be caused by pregnancy. In fact, CTS is a common complaint among pregnant women due to the increase in fluid build-up in the tissues, including the forearms and wrist. Edema is the technical term for fluid build-up, and it is hard to avoid during pregnancy. This swelling results in increased pressure on the median nerve that originates in the neck, travels through the shoulder, into the arm, through the wrist and innervates the thumb, index, third and half of the fourth finger. The “usual” initial symptoms include a “half-asleep“ sensation in the fingertips prompting the sufferer to shake and “flick” the fingers in attempt to “…wake them up.” These symptoms (with or without pregnancy) commonly occur at night, as many tend to sleep with wrists in bent positions. When we bend our wrist in any direction, the pressure inside the carpal tunnel will double.

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Carpal Tunnel Syndrome – What Is It?

CarpalTunnelCarpal Tunnel Syndrome (CTS) basically occurs when pressure is applied to the median nerve as it travels through the wrist on the palm side resulting in numbness, tingling, pain, and later, weakness of the grip and pinch functions. But, the median nerve can be pinched at many other locations as it courses down from the neck to the hand, which is why we examine and treat the CTS patient from the neck down! The median nerve has been described as the “eye of the hand,” as it is one of the three major nerves formed from the brachial plexus– that “highway” of nerves made up of the C5-T2 roots leaving the neck, merging together to eventually form the three main nerves of the arm. Because the median nerve function regulates pinch and grip strength, buttoning a shirt, writing a note, driving a car, and even sleeping are ALL affected by a median nerve pinch. But WHAT is CTS? Let’s take an “inside” look!

We know that fast, repetitive motion-related jobs like meat or fish packing plants, assembly line work, sewing occupations, and the like can cause CTS over time. Look at the palm side of your wrist and wiggle your fingers. Do you see ALL THE MOVEMENT that is occurring just before the wrist in the forearm? That motion is coming from the tendons, which like shoe strings, attach the forearm muscles to the fingers. Notice ALL the movement in your forearm muscles closer to the elbow – that’s a lot of motion! There are nine tendons that are covered by a lubricating sheath that help the fast moving tendons reduce friction, thus decreasing the chances for heat build up, swelling (inflammation), and subsequent pain and loss of function. But, there is a limit or threshold that the tendons and sheaths can withstand before they just can’t keep up. These nine tendons and sheaths are quite tightly packed together as they leave the forearm and enter the carpal tunnel.

The carpal tunnel is made up of eight small wrist bones called the “carpal bones,” and ANYTHING that makes that tunnel more narrow can effectively cause CTS. If we look at what happens INSIDE the tunnel in the CTS patient, the venous blood flow and nerve flow (called “axonal transport”) is blocked when the PRESSURE inside the tunnel occurs. We all know what it feels like when a blood pressure cuff is inflated on our arm – if it’s pumped up too high or left on too long, the arm REALLY HURTS! That’s because the blood can’t get past the inflated cuff and oxygen can’t get to our muscles and tissues past the cuff and IT CAUSES PAIN!

To give you an appreciation of the pressure difference between the normal vs. CTS wrist, normally, the pressure ranges between 2 and 10 mmHg. We pump up a blood pressure cuff to about 150-200 mmHg when we take blood pressure, so this is NOT MUCH! This 2-10 mmHg pressure increases when we change the position of our fingers, wrist and forearm with wrist extension (bending the hand backwards), causing the greatest pressure increase. This is why we fit the CTS patient with a wrist “cock-up” splint to be worn at night since you can’t control your wrist position when you sleep and any bent position increases the pressure and can wake you up due to numbness, tingling, pain prompting you to shake and flick your hands and fingers until they, “…wake up.” When CTS is present, the pressure inside the tunnel goes up exponentially, meaning NOT 2 or 3 times, but 6, 12, 24 times what is normal and even higher! Now, if you add wrist bending (extension > flexion), the pressure REALLY gets high and it doesn’t take long for the nerve pinch and blood loss to wake us up. We’ve previously talked about other conditions that can make developing CTS more common or make it worse like hypothyroid, diabetes, arthritis, kidney disease, and more. AGAIN, this is because an increase is pressure results from these conditions (increased swelling = increased pressure = increased symptoms). As chiropractors, we will guide and manage your care through the healing process of CTS using a conservative, NON-SURGICAL treatment approach – TRY THIS FIRST!

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for Carpal Tunnel Syndrome, we would be honored to render our services.

The Many Faces of Carpal Tunnel Syndrome

CarpalTunnelCarpal Tunnel Syndrome (CTS) was first reported in the late 1800’s and the first surgery was noted in 1933. In the beginning, CTS surgery was rarely performed, reportedly because the nerve pinch was present somewhere before the median nerve reached the wrist or carpal tunnel. In brief, possible compression sites include the cervical nerve roots (C5-7), the brachial plexus, thoracic outlet, above the elbow, in the proximal and/or mid forearm, and finally at the wrist/carpal tunnel.

Estimating the frequency of CTS is challenging due to the fact that the pinch or entrapment may include more than one area before the wrist resulting in double and multiple crush syndromes. One European study reported the incidence of CTS at 5.8% in women and 0.6% in men while another reported 3.4% in the United States. Even the causation of CTS is all over the board. For example, the annual incidence of CTS in automobile workers ranges between 1-10%, while in a fish processing plant, it was reported to be as high as 73%! To make this even more challenging, the cause of CTS is commonly associated with other conditions such as diabetes and pregnancy. In diabetics, CTS ranges between 14% and 30% and those who are pregnant have a 2% incidence. Even harder to report is the incidence of median nerve pinching proximal to the wrist as this ranges between as little as 1% to as high as 75% for pronator tunnel syndrome in already symptomatic women. Gender is also a factor as women are reported to be four times more likely to develop CTS than men. If there is NO other condition associated with CTS, the term “idiopathic” is applied, and this reportedly occurs 43% of the time.

Another issue making CTS a challenge to diagnose is the many risk factors associated with it, and sometimes studies are published that contradict one another about the possible risk factors. There are studies that report CTS is more likely to occur with conditions including: 1) Jobs or activities associated with wrist flexion or extension; 2) Hysterectomy without ovary removal; 3) Obesity; and 4) Varicosities in men. Some studies indicate risk criteria such as: 1) Use of birth control pills; 2) Age at menopause; 3) Diabetes; 4) Thyroid dysfunction; 5) Rheumatism; 6) Typing; and, 7) Pinch grasping. One study reported the highest incidence to occur in those with previous wrist fracture (Colles’ fracture), and common conditions included rheumatoid arthritis, hormonal agents or ovary removal, diabetes, and pregnancy. Another study reported obesity and hypothyroid as being risk factors, but not all studies support that theory. Certain medications have been reported to be associated with higher CTS risk including: 1) Insulin, 2) Sulfonylureas (diabetes meds); 3) Metformin; and 4) Thyroxin.

As doctors of chiropractic, we perform a thorough history, examination, and offer MANY non-surgical, non-pharmaceutical ways of treating CTS. Some of these approaches include: 1) Joint and soft tissue manipulation of the neck, shoulder, elbow, forearm, wrist, and hand; 2) Wrist splinting, especially at night; 3) Vitamin B6 and anti-inflammatory nutrients; 4) Home exercises for the neck, arm and hand; 5) Work station/ergonomic evaluations; 6) Dietary counseling for various conditions listed previously; 7) Co-management with primary care, rheumatology, neurology, orthopedics, and others.

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for Carpal Tunnel Syndrome, we would be honored to render our services.

Carpal Tunnel Syndrome and the Neck?

CarpalTunnelCarpal Tunnel Syndrome (CTS) is a problem that occurs when the median nerve gets pinched as it passes through the tunnel at the wrist, resulting in numbness that includes the palm side of the hand, the thumb through digit three and the thumb-side half of the ring or fourth finger. So, how does the neck fit into the cause and/or the treatment of CTS? Let’s take a look!

The neck is comprised of seven vertebrae and eight pairs of nerves that travel down the arms allowing us to feel sensations such as hot/cold, vibration, and sharp/dull. These nerves allow us to move our muscles and joints including the fingers, wrist, elbow and shoulder. These eight pairs of nerve roots, like a super highway of eight lanes of traffic, eventually merge into the ulnar, median, and radial nerves that extend down our arms. The median nerve is the primary nerve involved in carpal tunnel syndrome, so let’s take a look at the route that it takes as it leaves the cervical spine, or neck.

Initially, when the eight nerve roots first exit the spine they interconnect forming the brachial plexus, and by the time the nerves reach the arm pit, they’ve “merged” into the three main nerves that extend the rest of the way down the arm. The median nerve can become trapped or pinched at a number of different places, most commonly at the wrist’s carpal tunnel followed by the pronator tunnel which is located at the elbow just past the crease on the palm side. It can also be pinched before the elbow by a ligament that exists in about 1% of us (Struther’s Ligament).

If a fracture should occur anywhere along the route of the nerve, that too can cause a compression. The neck is a common location where the cause of the numbness can arise. The median nerve arises from three nerve roots that exit the neck (C5, C6, and C7); therefore, ANYTHING that places pressure at this location in the neck can result in similar symptoms as CTS.

The term, “double crush” syndrome applies to the situation where compression (pinching) of a nerve occurs in more than one place. This was first discussed in 1973 and has since been a debated topic. When a nerve is compressed in more than one location, there is a physiological change in the way the nerve transmits a signal and a minor (sub-clinical) compression that would by itself not be symptom-producing becomes symptomatic if a second compression occurs elsewhere along the course of the nerve. Similarly, metabolic changes, such as diabetes, can also make minor CTS symptomatic. This is why it is ESSENTIAL that the entire course of the nerve be tested, not just at the wrist but also at the neck, shoulder, and arm. I’m sure you can see the importance of this, as surgical decompression at the wrist may NOT help in a case where a more significant pinch is present elsewhere. This has been estimated to occur between 30-75% of the time! A common site for double crush with CTS is at the cervical nerve root, and treatment of the compression site in the neck by a chiropractic adjustment can MAKE OR BREAK a successful outcome when treating CTS. The bottom line? Try chiropractic FIRST as you can’t reverse an unnecessary surgery!