CARPAL TUNNEL SYNDROMETingling in the arms and handsCarpal Tunnel Syndrome usually awakens the sufferer in the early hours of the morning with tingling and sometimes an achy pain on the thumb side of the hand(s).
CTS is what is known as a double crush syndrome. While diabetes and an under-active thyroid need to be considered, the usual cause of CTS is an irritation of
Conditions such as pregnancy and wrist injuries that cause temporary fluid retention can also cause CTS. The Median nerve passes between the two heads of the Pronator Teres muscle in the forearm where an entrapment may also occur.
What is carpal tunnel syndrome?The bones of the wrist are called the carpals. The nerve that controls the thumb side of your hand, the median nerve, travels through a narrow tunnel especially created to protect the nerve. Carpal tunnel syndrome is a progressive condition caused by compression of the nerve, starting in the neck, perhaps in the forearm and finally in the carpal tunnel in the wrist. It may eventually cause weakness and wasting of the thumb muscles. How strongly can you press your thumb against the tip of your other fingers?
And can you see the transverse carpal ligament (in blue) that holds the bundle of tendons and the median nerve in place, and stabilise the wrist? More about that ligament later. What are the causes of carpal tunnel syndrome?There is little research proving that repetitive and forceful movements of the hand and wrist during work are the cause carpal tunnel syndrome. However it is suspected.Contrary to popular belief, research shows that computer use does not increase the risk of carpal tunnel syndrome. What does increase the risk of CTS is an old neck injury. Read more about how an "old whiplash" may cause IMMBOLISATION ARTHRITIS, one of the main causes of CTS.
Immobilisation Arthritis. Chiropractic examinationEarly diagnosis and treatment is important because of the risk of permanent damage to the median nerve. This starts with a good physical examination of the neck and the upper limbs. Your chiropractor will look for change in reflexes, weakness and atrophy of muscles, and sensory changes in the hands. In particular for 'two-point discrimination'. Can you distinguish whether one or two pins are pricking, comparing the effected and the uneffected hands, particularly when they are less than 10 mm apart.There are three important neurological tests:
Do these tests cause tingling or give electric shocks in the first three fingers? Nerve conduction tests, ultrasound imaging and MRI can be useful, but usually serve only to confirm what is already known. Lower Cervical Facet AnatomyThe lower neck is vitally involved in the Shoulder-arm-elbow-hand-syndromes and Why do we hiccup. These pages will give you an idea of the reasons behind it: Read more LOWER CERVICAL FACET ANATOMY >> Chiropractic treatmentDepending on where the nerve is being crushed, usually either in the neck, the forearm or the wrist, your chiropractor will use various techniques to release the pressure on the nerve. One of the common sites of the ‘double crush’ is between the first rib, the collar-bone and some neck muscles. The symptoms of Carpal Tunnel Syndrome often begin long after an injury to the collar-bone and upper thorax, in a fall for example on the outstretched arm.S/he may stretching the muscles of the forearm where the nerve is sometimes entrapped, as well as adjustments of any subluxations of the carpal bones in the wrist. Vitamin B6 reduces fluid retention and may help, particularly in pregnancy. Then there will be chiropractic rehabilitation of the joints and muscles to prevent re-occurence. S/he may recommend a reduction of heavy activities of the arm, and even a wrist splint.
Carpal Tunnel Case File >> Boston Carpal Tunnel Syndrome QuestionnaireDo you want to know how serious your Carpal Tunnel Sydrome is? Take this little test, and take it with you to your chiropractor. Also note which is your dominant hand, and whether you have symptoms in one or both hands.You must give ONE answer only, and if you have CTS in both hands, then fill in a sheet for each hand. The following questions refer to your symptoms for a typical twenty-four-hour period during the past two weeks (circle one answer to each question). The test comes in two parts: Symptom severity
Add up your scores, and divide by 12. A typical group of sufferes report an average of 3.4 Functional status
Once again, add up your scores, and divide by 8. A typical group of sufferers gave a result of 3.0 You should then repeat this questionaire (without looking at your first response) three months later. It will give you a reliable result of how effective the chiropractic treatment was. Reported dangers of surgeryRisks from the Carpal Tunnel Syndrome surgery include bleeding, infection, and nerve injury. Some pain, swelling, and stiffness can be expected. Minor soreness in the palm is common for several months after surgery. Severe problems are rare. You may be instructed to elevate your hand and move your fingers after surgery. This helps minimize swelling and stiffness.Most patients see their symptoms improve after surgery, but recovery may be gradual. On average, grip and pinch strength generally return by about 2 months after surgery. Complete recovery may take up to a year. If significant pain and weakness continue for more than 2 months, your physician may instruct you to work with a hand therapist. If carpal tunnel syndrome has been present longer and the nerve is more severely affected before treatment is attempted, recovery is slower and less complete. It is reported that corticosteriods injections usually bring only temporary relief and can contribute to tendon rupture.
FROM THE COAL FACE.Two months ago I was consulted my a man for severe pain in the leg whilst walking. At the same time he informed that he was scheduled in a week's time for a carpal tunnel syndrome operation.Perhaps foolishly, I decided to focus on why he came to see me: his leg. However, when he told me the pain was in his fourth and fifth fingers, I simply said it was most atypical of a carpal tunnel syndrome, and got on with the treatment of his sacro-iliac joint. No point rocking the boat. Yesterday, he was unable to shake my hand, his fingers were so painful. A quick examination confirmed that this was indeed no carpal tunnel syndrome. Diagnosis is important. It's little wonder the operation didn't help - the pain has nothing to do with the Median Nerve. In fact he has developed severe shoulder pain since the operation. Happily, the pain he has had in his leg is about 50% better, and he can walk for an hour with the dog with no great difficulty. He has now gone on 3 months holiday, and we will re-evaluate both his neck-shoulder-hand pain and the status of his sacro-iliac joint. FROM THE COALFACE II5 months ago a man consulted me with an acute right carpal tunnel syndrome. Tingling in the first three fingers of the right hand wakened him every night in the early hours. He had had the condition for 7 months - it was unresponsive to his doctor's treatment, and surgery was planned.The classic test of Phalen was strongly positive. I warned him that there was no strong research confirming that chiropractic helps CTS, but because he had a fixation of the first rib I was fairly certain I could help him. He came in this morning for his two month maintenance treatment. He declared the pain from his carpal tunnel syndrome is 95% over.
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