Carpal Tunnel Syndrome
By: Dr. Stephen O’Neil
Due to the very repetitive nature of many jobs in the workplace, carpal tunnel syndrome seems to be on the rise. Carpal tunnel syndrome is an entrapment of the median nerve in the tunnel where it passes though the wrist. Compression or entrapment comes from repetitive overuse of the hands or fingers usually associated with grasping type motions. These motions are extremely prevalent in the production industry, which populates this area. These movements cause a build up of inflammation and eventually scar tissue in this tunnel, which then compresses on the nerve. Other causes can be excessive typing, fluid retention (as in pregnancy), rheumatoid arthritis, diabetes and connective tissue disorders.
With median nerve entrapment the diagnosis is generally based on the patient's symptoms. Patients usually describe numbness and tingling in the middle two digits and weakness with gripping. The hand often feels clumsy or heavy. Pain is felt in the palmer part of the wrist and is worse with compression. The hallmark symptom of carpal tunnel syndrome is the numbness and tingling in the fingers which wakes the patient up at night. They often report waking up rubbing or clutching their own wrists. A final diagnosis may be confirmed by a neurologist using nerve conduction studies.
Medical treatment consists of anti-inflammatory drugs and surgery. However, many passive therapies should be explored prior to resorting to surgery. Many patients find great relief of symptoms or even resolution of the condition with passive therapies. Soft tissue techniques such as myofascial release or active relief therapy can help, especially when combined with chiropractic manipulation of the elbow and wrist joints. Electrical stimulation, especially with acupuncture can also significantly reduce symptoms. Specific stretching exercises can support treatment and break up the repetitive tasks of work. Nutritional supplements, especially B-complex vitamins can also greatly reduce symptoms for some patients. Some patients also find relief from wearing night splints on the hands while sleeping.
It is important to note that not all numbness and tingling in the fingers or hand is carpal tunnel syndrome. Carpal tunnel syndrome is quite commonly misdiagnosed. There are three major nerves that control the feeling and actions of the hands: the median, ulnar and radial nerves. Any of these may be entrapped at several locations in the wrist, elbow and forearm area. Many of these entrapment syndromes share some of the same symptoms as carpal tunnel syndrome but the treatment would be very different. Surgical resolution of some of the other entrapments is ineffective and unnecessary. A confirmed diagnosis of what is causing the symptoms in the hand or wrist must first be obtained before deciding on a proper course of treatment.
The use of passive therapies should be explored and exhausted before resorting to surgical alternatives. Your chiropractor can provide you with many alternative therapies and will be able to prescribe appropriated stretching and splinting procedures. Ergonomic advice regarding hand and wrist position during repetitive maneuvers such as typing or production factory work will also be of assistance. Make an appointment with your Doctor of Chiropractic to explore these options.