What is carpal tunnel syndrome?
Carpal tunnel syndrome is a common condition that causes pain, numbness, tingling, and weakness in the hand and wrist. It happens when there is increased pressure within the wrist on a nerve called the median nerve. This nerve provides sensation to the thumb, index, and middle fingers, and to half of the ring finger. The small finger (the “pinky”) is typically not affected.
Carpal tunnel syndrome was first described in the mid-1800s. The first surgery for the release of the carpal tunnel was done in the 1930s. It is a condition that has been well recognized by orthopedic surgeons for over 40 years.(3)
What are the symptoms of CTS?
Symptoms usually begin slowly and can occur at any time. Early symptoms include:
- Numbness at night.
- Tingling and/or pain in the fingers (especially the thumb, index and middle fingers).
In fact, because some people sleep with their wrists curled, nighttime symptoms are common and can wake people from sleep. These nighttime symptoms are often the first reported symptoms. Shaking the hands helps relieve symptoms in the early stage of the condition.
Common Daytime Carpal Tunnel Symptoms Include;
- Tingling in the fingers.
- Decreased feeling in the fingertips.
- Difficulty using the hand for small tasks, like:
- Handling small objects.
- Grasping a steering wheel to drive.
- Holding a book to read.
- Writing.
- Using a computer keyboard.
As Carpal Tunnel Syndrome Worsens, Symptoms Become More Constant
These symptoms can include:
- Weakness in the hand.
- Inability to perform tasks that require delicate motions (such as buttoning a shirt).
- Dropping objects.
In the most severe condition, the muscles at the base of the thumb visibly shrink in size (atrophy).(3)
Who Can Get CTS?
In short, anyone can. It generally affects people who use their hands and wrists a lot while working or playing. It is generally unusual to have it occur before the age of 20.
Who is at Risk of Developing Carpal Tunnel Syndrome?
People who are at risk for carpal tunnel generally have tasks that involve repetitive finger use. Common motions that are generally associated with the development of carpal tunnel syndrome are;
- High-Force
- Long-term use
- Extreme ranges of motions held for prolonged periods of time
- Using tools that have heavy vibration
Other Factors that can contribute to Carpal Tunnel Syndrome;
- Heredity
- Pregnancy
- Hemodialysis
- Wrist fractures or dislocations
- Hand or Wrist deformities
- Arthritic diseases
- Thyroid gland hormone imbalances
- Alcoholism
- A mass or Tumor
- Old age
- Amyloid deposits
(3)
Are there Other Sources of Hand Pain?
Arthritis: This is a general term for many conditions that cause stiffness and swelling in your joints. Arthritis can impact many joints in your body and symptoms range from causing small amounts of discomfort to breaking down the joint over time.
Trigger Finger: This condition causes soreness at the base of the finger or thumb. Trigger finger also causes pain, locking (or catching) and stiffness when bending the fingers or thumb
De Quervain’s tendinosis: A condition where swelling affects the wrist and base of the thumb. In this condition, you feel pain when you make a fist and simulate shaking someone’s hand.(3)
Double Crush Syndrome
Nerves operate off of a threshold. They are not simply turned on or off. They need to have sufficient input to justify sending an impulse. Here’s the catch, it does not need to be a singular input source. Let’s extrapolate this idea to carpal tunnel syndrome.
This is defined as “A numbness and tingling in the hand and arm caused by a pinched nerve in the wrist.” Now I believe this definition has been oversimplified. As we have learned it takes 1 big input or many small ones to cause a nerve to fire. So what is more likely to happen? Have a nerve distribution get pinched in multiple points along its pathway or have such a big anatomical shift that it causes enough compression at a single point? Well let’s let the surgical outcomes for carpal tunnel relief speak for the answer(Chung):
“The authors found that 75% of the workers with the diagnosis of CTS had surgery. The average return to work time after surgery was 3 months. Four years postoperatively, 46% had moderate to severe pain, 52% had moderate to severe numbness, and 40% had difficulty grasping and using small objects. Sixty-four percent of the study subjects returned to the same job and only 14% were symptom free.”(1)
So on top of the high cost of surgery you will likely not even have full resolution of symptoms. Why could this be?
Welcome to double crush syndrome. See the surgery only fixes one of the multiple inputs. So even post-surgery you could still have peripheral nerve entrapment in areas where the surgery was not even performed.
While the way I have described this initial concept of double crush may not be the most accepted version, other hypotheses for this concept exist to take this excerpt from (Novak):
“1. Certain postures or positions will increase tension or increase pressure at sites where nerves are entrapped. Placing a nerve under tension – e.g., the median nerve with wrist extension and the brachial plexus with arm elevation – may compromise neural blood supply. Pressure on a nerve at an entrapment site may cause increased neural edema, inflammation, fibrosis, and decreased neural mobility.
2. If a posture places a muscle in a shortened position, it will, over time, undergo adaptive shortening. When stretched, the shortened muscle may produce local discomfort, and if the muscle crosses over a nerve, the nerve may become secondarily compressed.
3. Abnormal postures will cause some muscles to be elongated or shortened (versus optimal musculoskeletal alignment). The muscles will undergo anatomic, biomechanical, and physiologic changes, resulting in muscle weakness. With weakness in some muscles, others will be recruited to compensate, and the cycle of muscle imbalance will continue.” (2)
This offers a more accurate revision of double crush syndrome in relation to what is known about nerve function currently. But does not entirely displace the original hypothesis.
How would we treat Carpal Tunnel at Align The Spine Chiropractic in Pewaukee?
At Align the Spine Chiropractic in Pewaukee, we would start with a patient consultation to discuss, in-depth, your history with Carpal Tunnel and any other hand/wrist-related nerve issues. Followed by a complete neurological assessment of the spine and extremities while performing specialized tests for the primary problem presented.
From here, we would acquire x-rays of any clinically indicated areas. Those x-rays would be read and explained by us, then sent to a specialist for a second opinion. Finally, we would perform chiropractic adjustments on clinically indicated areas. Then your care plan and its expectations would be explained by your doctor. Followed by an explanation of other therapeutic interventions that could take place during the course of your care plan such as ARPNeuro Therapy, cupping, and/or other manual therapies.
References
1.Chung, Kevin C. “Current status of outcomes research in carpal tunnel surgery.” Hand (New York, N.Y.) vol. 1,1 (2006): 9-13. doi:10.1007/s11552-006-0002-3
2.Novak CB, Mackinnon SE. Multiple nerve entrapment syndromes in office workers. Occup Med. 1999;14:39–59. [PubMed] [Google Scholar]
3.“Carpal Tunnel Syndrome: Risk Factors, Symptoms & Treatment.” Cleveland Clinic, my.clevelandclinic.org/health/diseases/4005-carpal-tunnel-syndrome.
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