Carpal Tunnel Syndrome (CTS) – What, Why, How?

WHAT? Carpal Tunnel Syndrome or CTS, is the most common of the peripheral nerve conditions where the median nerve is compressed or pinched at the wrist. The resulting symptoms include numbness/pain in the wrist, fingers (index, third, and forth), multiple sleep interruptions due to hand/finger numbness requiring frequent shaking and flicking, difficulty in gripping or pinching such as buttoning a shirt, threading a needle, lifting a coffee cup, frequent dropping of objects, and the inability to perform work duties. Pain can even shoot up the arm towards the shoulder and into the neck. Because there are 9 tendons over which lies the median nerve that pass through the rather tight tunnel made up of the 8 carpal bones of the wrist, even a little swelling can create CTS.

WHY? There are many possible causes but in general, whether its swelling, a spur, or a metabolic condition, the common denominator is median nerve pinch in the confined space within the carpal tunnel. A common cause of swelling can occur with performing repetitive motion work such as line assembly, meat packing, carpentry, and so on, and over time, the tendons inside the tunnel inflame or swell and the median nerve is pressed into the ligament that crosses over the roof of the tunnel on the palm side of the wrist. Once the contents inside the tunnel swell, all positions of the wrist other than neutral or, holding the wrist in line with the forearm further increases the pressure inside the tunnel. That is why sleeping with the wrist cocked in any direction often wakes up CTS patients. Those most at risk are women over 50 years of age. CTS can also be associated with other health conditions including (but not limited to) Lymes Disease, inflammatory arthritis, and hormone-related conditions including pregnancy, taking birth control pills (BCPs), hypothyroidism, diabetes, and menopause. Lifestyle issues that affect CTS may include high caffeine intake, smoking, alcohol consumption, as well as obesity.

HOW? So the key question is how are we going to help those with CTS? First, we must identify all the possible reasons why CTS developed in the first place and manage those issues. Therefore, an ergonomic (work place) assessment or, discussing and possibly observing the patient at work can be very helpful. Sometimes, a few simple changes to a work station such as moving the monitor of a computer in line with the keyboard/mouse or adjusting the height of the computer can really help. Changing a tool handle type (pistol vs. straight grip), propping up a part that is frequently worked on, moving the product closer to where it is being assembled, eliminate overhead reach requirements, standing on a raised platform, and so on, may be most important in long term results. Identifying and treating any condition that may be participating in the cause like thyroid disease, diabetes, medication (like BCPs), and weight management, is very important. Wearing a night splint is also very productive. Unique to chiropractic, treatments include manipulation of the neck, shoulder, elbow, forearm, wrist and fingers, soft-tissue therapy including massage, mobilizing the forearm muscles and tendons, teaching carpal stretch and other upper extremity exercises, and nutritional counseling. Strategies here can include eliminating any suspected food allergy related products including dairy, glutens (wheat, oats, barley, rye), soy, corn, transfats, preservatives and some chemical additives. Increasing B-vitamins (especially B6), by increasing dark leafy vegetables and, increasing antioxidants including fruits and veggies. An anti-inflammatory vitamin program of fish oil, Vit. D3, magnesium, CoQ10, and a multiple vit./mineral may facilitate as well. Once CTS is controlled, preventing a recurrence is important by promoting good posture, exercise, and sticking with the life style adjustments described above. If you, a friend or family member requires care for CTS, we would be honored to render our services.