Carpal Tunnel Syndrome

Have You got Carpal Tunnel Syndrome?
Have you ever had pain or numbness/tingling in the hand which are worse at night so that you shake your hand in the morning to relieve the pain? Do you have weakness in the hand or are clumsy when you are opening jam jars or trying to grip the steering wheel? Carpal tunnel syndrome has its name from its anatomical location. There is a nerve compression of the median nerve as it runs through a “tunnel” created by the transverse carpal ligament and the carpal (wrist) bones.

It is possible that this compression is due to ganglions, dislocations or fractures but it is more common to have a history of direct external pressure on the tunnel or a history of using the wrist in full flexion and extension.

Pressure inside the tunnel increases in extreme positions. Additional factors may have to do with fluid retention in pregancy, RA, diabetes and certain skin disorders. Certain tests can reveal the presence of carpal tunnel syndrome and some patients get referred for nerve conduction tests. Manual techniques as well as acupuncture may help with carpal tunnel. Ergonomic advice such as looking at hand and wrist position is important. Advice such as using rest pads for the wrist or using split keyboards can be helpful. “Manual techniques” refers to massage, deep tissue mobilization and manipulation of joints.

These procedures are performed by chiropractors as a mainstay of their treatment. Two recent scientific studies have shown that these techniques are helpful at reducing carpal tunnel symptoms. Sometimes scar tissue and tightness of the muscles of the forearms develop. Specific stretching exercises are used to allow more flexibility of the wrist. Your wrist joints, and the muscles that move the hand, are integrally linked. Disturbance in one system will over time affect the other area. When you have pain, you tend to move your wrist much less. Some patients even use braces and splints to reduce movement almost completely.

While this can be necessary for a few patients in the short term, over time it just makes the muscles inflexible and progressively weaker. This can lead to a vicious cycle producing even greater pain, which makes you move less. This cycle needs to be broken in order to regain function of the wrist again. It is important to mobilize the joints of the wrist and stretch the shortened muscles. It is also important to have a correct diagnosis before beginning treatment. Is the problem only in the wrist? Some patients will also have a neck sprain that makes the nerve that passes through the carpal tunnel more susceptible to pressure and inflammation. This is called the double crush syndrome because there is pressure at both the neck and the wrist.

Looking at your carpal tunnel symptoms in a comprehensive way can address many of the quality of life symptoms. Just covering up the pain with medication and not using your wrist anymore doesn’t really seem practical. Taking large amounts of pain and anti-inflammatory drugs (NSAIDs) can cause undesirable side effects. Stomach bleeding and irritation occurs in too many patients. In rare cases kidney and liver problems can develop.

We can diagnose the cause of your carpal tunnel symptoms. The examination may include x-rays the rule out certain diseases and to check the alignment of the wrist bones and neck vertebrae. Sometimes it’s the wrist that needs to be mobilized, and in other cases the neck is more the cause of the problem. With adjunctive manual techniques such as exercise, stretching, and deep tissue work, this combined approach can provide relief for many sufferers with this difficult problem.
Carpal Tunnel Syndrome
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