Carpal Tunnel Syndrome
What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is a painful disorder of the hand caused by pressure on your median nerve as it runs through the carpal tunnel of the wrist. Symptoms include numbness, pins and needles, and pain (particularly at night). Anything that causes swelling inside the wrist can cause carpal tunnel syndrome, including repetitive hand movements, pregnancy and arthritis.
What is Your Carpal Tunnel?
Your carpal tunnel protects vital structures such as the median nerve, blood vessels and tendons as they pass to and from your hand. The palm side of your wrist has a band of strong ligaments (flexor retinaculum) that attach to the carpal (wrist) bones at either side. The underside of the tunnel is made up of the wrist bones.
What's the Cause of Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome symptoms begin when the pressure inside the tunnel becomes too high. This results in your median nerve becoming compressed as it passes through the small tunnel.
The carpal tunnel pressure increase occurs when either of two things happens:
- The tunnel space decreases, such as when the wrist swells eg after a traumatic injury, partial subluxation of the carpal bones or fracture or tenosynovitis.
- When the contents of the tunnel (median nerve, blood vessels and tendons) enlarge.
Both of these situations increase the pressure on the nerve, leading to the carpal tunnel symptoms.
Other Common Causes of Carpal Tunnel Syndrome
Frequently, the median nerve is compressed elsewhere along its path - not in the carpal tunnel - and replicates carpal tunnel symptoms. Most often compression occurs in your neck but can occur anywhere along the nerve path as it travels to your hand. This entrapment predisposes the nerve to develop carpal tunnel symptoms.
How does this occur?
A nerve may become slightly squashed (e.g. by a bulging neck disc or build-up of swelling). Your nerve will not receive adequate supply of the fluid which provides its nutrients and you may experience carpal tunnel symptoms.
It is important to confirm the site of your nerve compression. There are many patients over the years who have had carpal tunnel surgery performed without benefit, because the carpal tunnel symptoms originated from nerve compression elsewhere. This condition is known as “double crush syndrome”.
Potential Compression Sources
Your symptoms can originate from elsewhere along the median nerve. This source is frequently overlooked, and could save you from unsuccessful surgery. Your lower cervical spine especially C6, C7, C8 and T1 should be thoroughly examined by your chiropractor. This is known as “double crush syndrome” and there is an increased likelihood of carpal tunnel syndrome in these patients.
Your nerves should freely travel along their pathways between your spine and your fingers. Any interference of their slide mobility could cause symptoms eg. scar tissue, tight muscles. Your chiropractor can assess your neurodynamics for abnormalities.
Gripping, Repetition and Microvibration
Occupations associated with repetitive wrist flexion and extension activities, vibratory tools, and gripping have a high incidence of carpal tunnel syndrome.
What’s the Symptoms of Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome (CTS) sufferers will usually experience the following symptoms in their hand or fingers:
- hand pain or aching
- pins and needles
- numbness especially at night and with wrist flexion
- weakness or cramping
- perceived swelling
The symptoms are usually worse at night and your grip will weaken as the condition progresses. Eventually you will notice muscle atrophy of the thenar (thumb) muscles and loss of hand function or clumsiness. If this sounds like you, suspect carpal tunnel syndrome.
Shaking the wrist may ease symptoms temporarily.
How is Carpal Tunnel Syndrome Diagnosed?
Your chiropractor will generally diagnose carpal tunnel syndrome based on your symptoms. They use various tests such as Phalen’s test, Tinel’s test or the wrist flexion/median nerve compression test that compress the carpal tunnel. It is also important to thoroughly examine your lower neck and upper back joints, plus your nerve tissue mobility - neurodynamics.
Your chiropractor may refer you back to your doctor to request nerve conduction studies or EMG studies to quantify if your nerve electrical impulses are slowed by compression within the carpal tunnel or further up the arm.
Ultrasound may reveal median nerve enlargement. X-ray may identify coexisting pathologies. MRI, CT scans are not normally required.
Carpal Tunnel Syndrome Treatment
Rest & Patient Education
Resting from the aggravating cause is important. Education and awareness about what the symptoms and what positions or activities potentially cause carpal tunnel syndrome is important.
Night Wrist Splint
A night-time wrist splint is beneficial to eliminate wrist bending and therefore carpal tunnel symptoms. Your chiropractor may recommend a splint.
Chiropractic is beneficial for most carpal tunnel sufferers especially in mild to moderate cases. Treatment varies depending on the cause but may include- Dry needling, soft tissue massage, muscle releases and adjustments/ mobilisations to the joints of the arm and neck.
Carpal Tunnel Syndrome Prognosis?
Mild to moderate sufferers of carpal tunnel syndrome have a favourable prognosis from conservative treatment. The best results occur within the first three months of treatment. Severe cases, especially those with thenar muscle atrophy, are more likely to require surgical release of the carpal tunnel.
Chronic carpal tunnel syndrome can end in neural fibrosis, resulting in permanent nerve damage that will not respond to conservative or surgical treatment.
If you have any of these symptoms or you think Chiropractic care might help you then contact us on
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