Carpal tunnel syndrome (CTS) is a painful condition involving the hand and wrist.  Symptoms often include numbness, tingling, weakness, or muscle-wasting in the thumb and index finger.  The fingers may also have a tendency to feel swollen, although no swelling is present.  All of these symptoms are attributed to an irritation of the median nerve as it passes through the carpal tunnel.   

 

 

The carpal tunnel is an opening in the wrist that allows for the passage of nerves, tendons and blood vessels that supply the hand.  This opening is formed on one side by the carpal bones of the wrist, plus a connective tissue sheath called the flexor retinaculum on the other side. 

 

 

Since the carpal tunnel is a physically limited space, any swelling or inflammation within this space will also cause compression of the median nerve.  One of the most common causes of this compression is the inflammation of the tendons passing through the carpal tunnel.  This irritation is usually associated with repetitive activities involving the small muscles of the hand, like typing, knitting or sewing.

 

 

Although people working at a computer station are thought to be the most prone to CTS, The National Institute of Neurological Disorders and Stroke (NINDS) estimates that assembly-line workers are three times more likely to suffer from CTS than data-entry personnel.¹ Women are also more likely to be treated for CTS, and NINDS suggests that this may be due to the fact they have smaller carpal tunnels than men.

 

 

Although a true case of CTS is attributed to the compression of the median nerve at the wrist, irritation anywhere along the length of this nerve can lead to symptoms that mimic this syndrome.

 

The median nerve leaves the spinal cord at the lower part of the neck, where it starts out as a series of nerve ‘roots’.  These nerve roots then coalesce to form part of the brachial plexus.  The brachial plexus then divides into several more specific nerves, at which point the median nerve becomes a distinct nerve. 

 

 

Vertebral subluxations (misalignment/restriction) can cause irritation and/or inflammation of the nerve roots, as they pass very close to the joints and discs of the neck. 

 

 

Chiropractors are specifically trained in the art of locating and correcting sources of nerve interference caused by joint restriction and irritation.  Orthopedic and neurological tests are used to determine where the source of irritation is, and chiropractic adjustments are used to restore proper mechanical function of the involved joints – usually in the spine, but also in other joints, like the wrist, elbow or shoulder.²

 

 

Tight muscles are also a potential problem. The median nerve must pass through or around several muscles on its way to the arm and hand.  Specific muscles that can be involved include the scalene muscles of the neck, the pectoral muscles of the chest, and the flexor muscles of the forearm.  Tightness or inflammation of any of these muscles may serve as a source of irritation to the nerve.  If positions that stretch or tighten these muscles reproduce symptoms, it’s likely that this could be contributing to CTS. 

 

 

When it comes to carpal tunnel syndrome, prevention of the problem is always recommended.  You should …

 

• Make sure that your work station is ergonomically set up. It’s one of the best ways to avoid improper posture and repetitive strain, both of which may contribute to CTS.
• Take regular breaks from repetitive movements.
• Stretch the muscles of the forearm, chest and neck.

Other factors that have been shown to contribute to CTS include tobacco, caffeine and alcohol consumption.³  Diabetics have also been shown to be more susceptible to experiencing the symptoms of CTS.⁴

 

 

If you start to feel the symptoms of CTS, place a cold-pack on the wrist for approximately 10 minutes at a time, several times a day, in an attempt to decrease inflammation in the area.  Consult with your chiropractor to ensure that you have proper positioning and movements of the joints and to test whether there are other contributing factors in addition to compression of the carpal tunnel.  Studies have shown chiropractic care to be an effective tool to reduce the symptoms of CTS.^5,6 

 

 

If chiropractic treatments are not helping, consult with your MD for a referral to an orthopaedic specialist.  Sometimes surgery is the only option that will be effective to reduce the symptoms of CTS. Wrist splints/braces can also be used to minimize movements that aggravate your symptoms, especially for people who bend their wrists at night while they sleep. 

 

 

I have successfully treated a number of individuals with CTS in my practice.  Sometimes the main problem is in the wrist itself, and a combination of therapies – namely joint manipulation of the wrist with an application of Trigenics® to the muscles of the forearm – resulted in a complete resolution of symptoms.  Other times, assessment of the neck revealed major subluxations at the lower level of the neck, and chiropractic adjustments in this area was the treatment of choice. I’ve only had to refer a small number of patients back to their MD for more specialized assessments and treatment. 

 

Given the cost of surgery, together with the time taken to recover from the surgery itself, a short course of conservative therapy is always recommended before resorting to more invasive procedures.  Look for a chiropractor who has knowledge and experience in treating soft tissues as well as performing chiropractic adjustments. Trigenics® — Applied Functional Neurology, Active Release Techniques® and Graston® Technique are some of the more popular manual treatment methods used by chiropractors. Be sure that the chiropractor is certified in the techniques used before making an appointment to see them.  Each protocol requires the therapist to attend many hours of instruction before becoming certified as being competent in delivering care.

 

Dr. Christian Guenette

Chiropractor, Trigenist, Certified Life Coach

http://www.back2health.ca

 

References and sources:

1. The National Institute of Neurological Disorders and Stroke – a branch of the National Institutes of Health.  Carpal Tunnel Syndrome Fact Sheet.  Published November, 2002. http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm

2.  Valente R, Gibson H: Chiropractic manipulation in carpal tunnel syndrome. J  Manipulative Physiol Ther 1994;17(4):246-249.

3.  Nathan PA, Keniston RC, Lockwood RS, Meadows KD: Tobacco, caffeine, alcohol, and carpal tunnel syndrome in American industry: a cross-sectional study of 1464 workers. J Occup Environ Med 1996, 38:290-298.

4.  Dellon AL, MacKinnon SE, Seiler WA: Susceptibility of the diabetic nerve to compression. Ann Plast Surg 1988, 20:117-119.

5.  Davis PT, Hulbert JR, Kassak KM, Meyer JJ. Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trial. J Manipulative Physiol Ther. 1998;21(5):317-326.

6.  Perez R, Auyong S: Chiropractic manipulative therapy of carpal tunnel syndrome. J Chiro Med 2002;1:75-78.