Carpal Tunnel Syndrome - Can Chiropractic Help?

Hi there loyal readers! This is my last post for 2011 and I would like to thank you all for your support and interest in my blog! Learning about your health is the most important thing you can do - so visiting here often will put you on the right track for a great 2012! I look forward to posting more on the health issues you want to know about in the new year - leave me a comment and let me know what interests YOU!

Today's post reviews and explains a very common and debilitating health issue - Carpal Tunnel Syndrome. The National Center for Health Statistics has reported that Carpal Tunnel Syndrome results in the highest number of days lost among  all other work-related injuries. It is the most common nerve compression disorder of the upper limb. Here is what you need to know about this painful health condition:

What is Carpal Tunnel Syndrome?

The carpal tunnel is a narrow, rigid passageway formed of bones and ligaments at the base of your hand. Nine tendons and one nerve (the median nerve) pass through this space. Carpal tunnel syndrome (CTS) occurs when the median nerve becomes pressed or squeezed at the wrist. Thickening from irritated tendons or other swelling narrows this tunnel and, since it is mainly composed of bones, the tunnel cannot stretch to accommodate this inflammation. This results in compression and irritation to the median nerve (neuropathy), leading to painful sensations. Although these sensations may indicate other conditions, CTS is the most common and widely understood of the entrapment neuropathies in which the body’s peripheral nerves are compressed or traumatized.

The Median Nerve:

The median nerve exists in humans as well as other animals. It originates in the neck and courses down the arm into the wrist, where it passes through the carpal tunnel. This nerve controls the sensations to the palm side of the thumb and fingers (not including the little finger), as well as impulses to some small muscles in the hand that control finger and thumb movement. Due to the course of the nerve, compression at the carpal tunnel can result in pain, weakness, or numbness in the hand and wrist, radiating up the arm.

Symptoms:

-pain, tingling or numbness in the thumb or fingers

-pain from your hands, up the arm which may extend to your shoulders or neck

-a swollen or ‘tight’ feeling in your hands or wrists

-hands or lower arms may feel weak in the morning

-you may drop things more than usual

-you may have trouble pinching or grasping objects

-you may have trouble with detail tasks, such as writing or tying your shoes

-you may have trouble with strength tasks, such as opening sealed jars or using a screwdriver

Who Gets CTS?

Anyone can be afflicted with CTS, but there are a number of risk factors that may cause some to develop it more than others:

Age: As we age, the chance of developing CTS increases. This syndrome is very rare in children.

Gender: Many studies have indicated that women have a significantly higher risk for developing CTS as compared to men. According to the National Institutes of Health, women are three times more likely than men to have CTS (sorry, ladies...!). This may be due to the smaller size of the wrist in women, and hormonal changes appear to play a major role in CTS as well. CTS is common during pregnancy, but is usually less severe. Although most cases eventually go away on their own following delivery, symptoms may persist for 6 months or more. CTS has also been associated with menopause. On top of all of this, women are also at a much higher risk for autoimmune disorders than men are, and these disorders are significantly linked to CTS.

Obesity: Being overweight is a major risk factor for CTS and may play a direct causal role on the syndrome’s development. Why? I’m glad you asked! Having a greater body mass has been shown to reduce the speed of nerve signals into the hand. Obesity is also related to poor physical fitness, which may also increase the risk. A 2005 study indicated that increased weight is strongly linked to the onset of CTS in patients under the age of 63, but may be a less important risk factor as these patients get older.

Changes in Anatomy: A fracture or dislocation of the wrist may alter the space within the carpal tunnel, creating extraneous pressure on the median nerve. Also, as I have explained above, the physiologically smaller wrists seen in women can increase the risk for CTS as there is less room for error. It has been shown that women who have CTS have smaller carpal tunnels than women who do not have the syndrome.

Nerve-damaging Conditions: Certain chronic illnesses, such as diabetes and alcoholism (among many others), increase your risk of nerve damage, including damage to the median nerve.

Inflammatory Disorders: Illnesses that are characterized by inflammation, such as rheumatoid arthritis, infections and certain cancers, can affect the fluid levels and tendons in your wrist, increasing the pressure on your median nerve.

Changes in Body Fluid Balance: Conditions such as pregnancy, menopause, thyroid disorders and kidney failure – among others – have an effect on the level of fluids in your body and can cause fluid retention. If you are retaining fluid, the pressure within your carpal tunnel may increase and irritate the median nerve.

Workplace Factors: If your job requires you to use your hands and wrist repetitively, you are at greater risk for developing CTS, particularly if you work in cold temperatures! Although CTS is common among computer users, the evidence is weak for implicating this type of job as a risk factor for CTS. Workers in the meat and fish-packing industries, and those who assemble airplanes have the highest risk for CTS. The incidence of CTS in the meat, poultry, and fish packing industries may be as high as 15%! Musicians are also at very high risk for CTS, with studies reporting that 20% are afflicted.

The following is a list of occupations published by the Bureau of Labor Statistics in 2006 rating workers with highest to lowest total numbers of CTS-related events:

• Laborers and freight, stock, and material, movers
• Customer service representatives
• First-line supervisors/managers of office and administrative support workers
• Janitors, maids, and housekeeping cleaners
• Food service managers
• First-line supervisors/managers of retail sales workers
• Automotive service technicians and mechanics
• Executive secretaries and administrative assistants
• Financial managers
• Sewing machine operators
• Truck drivers
• Office clerks
• Accounting and auditing clerks
• Welders, cutters, solderers, and brazers
• Sheet metal workers
• Packers and packagers
• Computer software engineers
• Inspectors, testers, sorters, samplers, and weighers
• Stock clerks and order fillers
• Tire repairers and changers
• Packaging and filling machine operators and tenders

SOURCES: Bureau of Labor Statistics, U.S. Department of Labor, November 2006

Not Just at Work! Those who cook intensively, sew, knit, do needlepoint, play computer and video games, do carpentry or use power tools are at an increased risk for CTS! Long-distance cycling may also make the symptoms of CTS worsen.

Cigarette Smoking and Alcohol Abuse: Cigarette smoking slows down your blood flow, which leads to worse CTS symptoms and a slower recovery than non-smokers. Increased alcohol intake has also been associated with CTS.

Medical Treatment:

The most common medical treatment for CTS is a surgical procedure known as carpal tunnel release. This operation is one of the most common surgeries performed in North America. It is generally recommended if symptoms last for 6 months and it involves cutting the carpal ligament (the fibrous band of tissue that closes the carpal tunnel) to reduce pressure on the median nerve. This surgery is done under local anesthesia and is an out-patient procedure. The majority of patients require the operation on both wrists.

Although symptoms may be relieved immediately following surgery, a full recovery from this procedure can take up to a year. Some patients may develop an infection, nerve damage, stiffness, and pain at the location of the scar. In some patients, the wrist looses strength because the carpal ligament has been severed. It is highly recommended that patients undergo some form of physical/chiropractic therapy to restore wrist strength. Some patients may need to adjust their job duties or even change professions following this procedure.  

Research has shown that, in 70% of cases, some improvement is achieved. Full restoration is accomplished in less than 60% of carpal tunnel release surgeries. It is highly recommended that alternative therapies, like chiropractic, be sought out before deciding on the surgical route.

How can Chiropractic Help?

CTS is commonly treated by chiropractors! As you have just learned, the median nerve extends from your spine to your finger tips. Your chiropractor will examine you for proper mobility and positioning in all the areas that the nerve passes through. After you have been assessed, your chiropractor will utilize specific methods to reduce the irritation to the nerve along its length. The most common treatments include manipulation to the upper spine, shoulder, elbow and wrist. Wrist supports, specifically for while you are sleeping, will almost always be prescribed. Your chiropractor will also address your posture and/or ergonomic concerns. Incorrect posture or wrist positioning during your repetitive tasks can aggravate the symptoms of CTS. Chiropractic care offers drug-free, non-surgical treatment for CTS patient and has been proven to yield excellent, long-term results.