CARPAL TUNNEL SYNDROME

Tingling in the arms and hands

Carpal Tunnel Syndrome usually wakes sufferers in the early hours of the morning with tingling and sometimes an achy pain on the thumb side of the hand(s).

Often it is worse in your dominant hand, BUT perhaps the tingling has started in the other hand too? Does the pain spread up into your forearm? Tingling in the arms and hands? You probably have Carpel Tunnel Syndrome. It effects the Median nerve.

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 nerves in the neck AND the wrist or forearm.

Conditions such as pregnancy and wrist injuries that cause temporary fluid retention can also cause CTS.

Sites of injury are in the lower neck, around the elbow and in the wrist.

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?

Can you seen the tunnel formed by the carpal bones, surrounding and protecting the flexor tendons that control the fingers, and the yellow median nerve?

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.

Chiropractic examination

Early 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:

Tinel�s test, in which s/he will tap on the median nerve in your wrist.
Phalen's test, a wrist-flexion test is done by pressing the backs of the hands together.
Adson�s test in which the pulse in your wrist will be tested, while turning the head and taking in a deep breath.

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.

Chiropractic treatment

Depending 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 CTS 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.

Reported dangers of surgery

Considerations. Risks from the 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.

Recovery. 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.
Dangers of anti-inflammatory drugs such as Ibuprofen

Are there risks from chiropractic treatment? It must be acknowledged that no treatment exists that is not without some element of risk. There is no treatment of the upper cervical spine, where most potential (albeit extremely rare) complications may occur.
For dangers of chiropractic treatment

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