Carpal Tunnel

CTS Exercises?

~ Dr. Robert Speirs DC ~ Leave a comment

​CTS Stretch

Carpal Tunnel Syndrome (CTS) is the leading cause of numbness to the middle three fingers and thumb and affects millions of Americans each year. There are MANY potential causes of CTS, and these causes can be unclear or multi-factorial. We have discussed the importance of night splints and what chiropractic can do for CTS in the recent past. This month, let’s look at what YOU can do for CTS.
“Self-help” concepts are VERY important as they empower YOU to gain control of your condition’s signs and symptoms, thus placing less reliance on those of us who manage (in this case) CTS. There is a time for “PRICE” or, Protect, Rest, Ice, Compress, Elevate, such as when most activities make symptoms worse. This is the time for splinting, reducing activities of daily living (which sometimes includes work restrictions), and the use of ice cupping or massage. Patients should initiate movement or exercise-based approaches as soon as such activities can be tolerated. Here are four different exercises you can do:
1. Fist / “Bear Claw” / Open Wide Hand: This is a three-step exercise, and you can start or stop on any of the three “steps.” A. FIST:  Make a fist and squeeze as tightly as tolerated; B. BEAR CLAW: Starting from the fist position (A), open only the palm of the hand (keep your thumb and fingers bent but straighten the big knuckle joints at the base of the fingers); C. OPEN WIDE: Straighten and spread ALL your finger joints by opening up your hand as much as possible and feel for a good stretch in the palm. HOLD each position for one to five seconds (vary the “speed” of moving between the three positions – fast, medium, and slow; emphasize what feels best if you have a preference). Repeat five to ten times or until your hands feel looser.
2. “Church Steeple”: Place your hands together in front of you (“prayer position”) touching the pads of the thumbs and all four fingertips together and spread your fingers as wide as possible. Next, separate your palms as far as you can while applying pressure against your finger/thumb tips and repeat. Alter the speed and number of repetitions until your hands feel stretched out.
3. “Shake and Flick”: Simply shake your hands as if you just washed them and you’re shaking the water off to “air dry” them. Again, alter the speed and reps until they feel loosened up.
4. Forearm Stretches: Place one arm out in front, elbow straight, and fingers pointed straight, palm up (first set). Reach with the opposite hand and pull the fingers, hand, and wrist down and back towards you until you feel a strong “pull” in your forearm muscles. Hold until the forearm muscles feels stretched (5-10 seconds). Repeat this with the palm facing down for the second set to stretch the opposite (extensor) forearm muscles.
Do these on each side two to three times each (even the “good” side) EVERY HOUR (or as often as possible). Think about what you do on a daily basis and if you work in a repetitive manner (on the job or a hobby at home), try to do these exercises DURING THE REPETITIVE ACTIVITY to help keep your symptoms from getting out of control. If you can alter the position or speed of a work or avocational activity, do so for long-term prevention purposes!
If you cannot gain control of your CTS condition, you may need additional treatment options of which chiropractic offers a safe, non-surgical approach.
We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for Carpal Tunnel Syndrome, we would be honored to render our services.

Carpal Tunnel Syndrome #3

~ Dr. Robert Speirs DC ~ Leave a comment

​This week, we will conclude our three-part series on important facts regarding carpal tunnel syndrome (CTS).

CTS TREATMENT OPTIONS (continued): Aside from the carpal tunnel, there are several places where the median nerve can become compressed as it travels from the neck, down through the shoulder, through tight muscular areas of the upper arm and forearm, and finally through the carpal tunnel at the wrist. In order to achieve good, long-lasting results, treatment must focus on relieving compression at any point along the course of the nerve. This is why chiropractic works SO WELL as it addresses ALL of these areas using manual adjustments, muscle release techniques, and even physical therapy modalities.

CTS PREVENTION: Because there are multiple causes of CTS, prevention must be tailored to each person. For example, if the patient has diabetes mellitus, maintaining a proper blood sugar level is very important because the blood becomes thicker as the sugar levels increase and it simply cannot pass through our small blood vessels (capillaries), especially those located in the feet and hands. This can eventually lead to the need for amputation due to poor circulation and contribute to the numbness associated with diabetic neuropathy.

Similarly, low thyroid function results in a type of swelling called myxedema that can cause or worsen CTS, and keeping the thyroid hormone balanced in the bloodstream is very important. Managing other conditions that create inflammation or swelling, such as rheumatoid and other types of arthritis, will also help prevent CTS from developing or worsening.

Carpal tunnel syndrome can also occur during pregnancy due to the hormonal shifts similar for those taking birth control pills. The PRICE treatment options presented last month can be very helpful for the pregnant mother and represent important non-medication self-care approaches.

Certain occupations that require fast, repetitive work and/or firm gripping can result in carpal tunnel syndrome because of the friction that results in swelling that occurs when the muscle tendons inside the carpal tunnel rub excessively fast together (kind of like starting a fire with two sticks). Modifying the work task until the swelling is controlled is VERY important, as discussed last month.

Other preventative measures include exercises that keep the muscles and tendons in the forearm and inside the carpal tunnel stretched so that the tendons easily slide inside their respective muscle tendon sheaths. This is accomplished by placing the palm side of the hand (elbow straight) on a wall with the fingers pointing downwards while reaching across with the opposite hand and pulling the thumb back until you feel a good firm stretch. Hold this position for 5-10 seconds or until the forearm muscles feel like they are relaxing. Repeat this multiple times a day.

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for Carpal Tunnel Syndrome, we would be honored to render our services.

Carpal Tunnel

Carpel Tunnel in a nutshell

~ Dr. Robert Speirs DC ~ Leave a comment

Here it is: carpal tunnel syndrome (CTS) in a nutshell!

 

WHAT: CTS is caused by an injury to the median nerve (MN) as it travels through the wrist.
WHERE: The eight small carpal bones and a ligament form a tunnel in which tendons and nerves pass through to reach the hand.
HOW: The MN gets pinched/irritated from repetitive stress.
WHY: The tunnel is tight as it includes the MN and nine rapidly moving muscle tendons!
PROGRESS: CTS usually starts slow and often progresses over weeks, months, even years.
SYMPTOMS: Pain, numbness, tingling, and/or weakness of the hand, sparing the little finger.
PROGNOSIS: CTS is easier to treat shortly after it starts, and waiting too long to seek care may lead to worse outcomes.
RISK FACTORS: 1) family history (genetics); 2) women are more likely to suffer from CTS than men; 3) age over 50; 4) manual jobs; 5) pregnancy; 6) conditions like diabetes, hypothyroid, rheumatoid arthritis (RA), osteoarthritis, autoimmune diseases (includes RA, certain types of thyroid disease), gout, kidney disease (especially dialysis patients), Down syndrome, amyloidosis, acromegaly, tumors on the median nerve; 7) medications (those that affect the immune system such as interleukin-2, possibly corticosteroids), anti-clotting drugs such as warfarin, hormone replacement, BCPs; 8) obesity; 9) smoking; 10) alcohol abuse; and 11) trauma/injuries (fractures, tendonitis).
TREATMENT: Ideally, treatment should begin as soon as possible after symptoms first start, but this RARELY occurs due its slow and gradual onset. Non-surgical care includes anti-inflammatory care (ice, anti-inflammatory nutrients—ginger, turmeric, bioflavonoids; NSAIDs like ibuprofen), wrist splinting (primarily at night), corticosteroid injections, job/ergonomic modifications, exercises (yoga, stretching, strengthening, and aerobic fitness), low level laser therapy, ice, acupuncture, and chiropractic care. Chiropractic care includes MANY of the above PLUS manual therapies applied to the neck, shoulder, arm, wrist, and hand.Carpal Tunnel

What is CTS?

~ Dr. Robert Speirs DC ~ Leave a comment

480px-Carpal_Tunnel_Syndrome​

Carpal tunnel syndrome (CTS) is a very common condition. According to a report by the Bureau of Labor Statistics (BLS), CTS ranks SECOND among the major disabling diseases and illnesses in ALL private industries. The BLS states that workers with CTS may eventually have to give up their livelihood. They cite one study in which almost half of all CTS patients changed their jobs within 30 months following their diagnosis. Due to the controversy surrounding the issue of CTS and worker’s compensation, workers do not always receive compensation benefits.
The KEY to long-term cost containment associated with CTS is EARLY DIAGNOSIS and PREVENTION! The challenge is getting the worker to identify early symptoms and NOT feel intimidated to report them, which could then lead to prompt care and possibly job modifications, resulting in the best chance of preventing a more complicated and far more costly problem.
Because of the many factors that contribute to and/or cause CTS, there is similarly no one way to prevent it from happening. Treating any/all underlying medical condition(s) is important. Using simple common sense can go a long way to help minimize some of the risk factors that predispose a person to work-related CTS and other cumulative trauma disorders (CTDs).
For example, watching and mimicking veteran workers can be a great guide as to how to maximize efficient work methods while minimizing unnecessary stresses and strains. Other preventative “tricks” include learning how to adjust the work area, handle tools, or perform tasks that minimize hand/wrist strain. Maintaining proper posture and exercise programs to strengthen the fingers, hands, wrists, forearms, shoulders, and neck may also help prevent CTS.
Many companies have taken action to help prevent repetitive stress injuries. In one study, 84% of the companies surveyed reported that they were modifying equipment, tasks, and processes as part of a prevention effort; nearly 85% analyzed their workstations and jobs; and 79% purchased more ergonomic equipment. Unfortunately, there is NO EVIDENCE that any of these methods can completely protect a worker against CTS. Often, the best approach is to relocate the worker to a less repetitive job, but this is not always an option.
Doctors of chiropractic can observe the worker through a video or during a factory tour/visit and often identify ergonomic problems that can result in a low-cost, easy modification. Simple modifications coupled with quality care, patient education, and cooperation from BOTH the worker and the employer can typically help yield the best outcome for the CTS patient.

Do you have CTS?

~ Dr. Robert Speirs DC ~ Leave a comment

​Carpal Tunnel

Carpal tunnel syndrome (CTS) can be an extremely painful and activity-limiting condition. It affects many people of all ages and genders, though women are affected more often than men. But how do you know if what you are suffering from is truly CTS or if it’s another condition that’s producing the symptoms in your hand or wrist?
Carpal tunnel syndrome occurs when the median nerve is compressed as it passes through the wrist. However, the median nerve travels out of the neck, through the shoulder, elbow, and forearm before it passes through the wrist and into the hand. Pinching of the median nerve ANYWHERE along its course can give rise to the signs and symptoms of CTS including numbness, tingling, and/or pain into the hand and index, third, and thumb-side half of the fourth digits, and sometimes the thumb. If the pinch is significant enough, weakness can also occur. Sometimes the median nerve can become compressed at both the wrist and other body sites as it travels from the spinal cord to your hand, that’s why it’s important for a doctor to check for impingements along the entire course of the nerve.
 
But compression of the median nerve isn’t the only thing that can produce symptoms in the hand. Here are a couple of the more common conditions that are often confused with CTS:
1)  Ulnar neuropathy: This is pinching of the ulnar nerve (at the neck, shoulder, elbow, or wrist) but this gives rise to a similar numbness/tingling BUT into the pinky-side of the fourth and the fifth fingers (not the thumb-side of the hand). The most common pinch location is either at the neck or the inner elbow, the latter of which is called “cubital tunnel syndrome” or CuTS.
 
2)  Tendonitis: There are a total of nine tendons that pass through the carpal tunnel that help us grip or make a fist. Similarly, there are five main tendons on the back side of the hand that allow us to open our hands and spread our fingers. ANY of these tendons can get strained or torn, which results in swelling and pain as well as limited function BUT there is usually NO NUMBNESS/TINGLING!
 
3)  DeQuervain’s disease: This is really a tendonitis of an extensor tendon of the thumb and its synovial sheath that lubricates it resulting in a “tenosynovitis.” This creates pain with thumb movements, especially if you grasp your thumb in the palm of your hand and then bend your wrist sideways towards the pinky-side of the hand.
 
Chiropractors are well-trained to diagnose and treat patients with CTS. And if you don’t have CTS but another condition listed above, they can offer treatment (or a referral, if necessary) to help resolve it so you can return to your normal activities as soon as possible.

Effective Treatment of Carpal Tunnel Syndrome: Chiropractic Care and Laser Therapy

~ Dr. Robert Speirs DC ~ Leave a comment

Carpal tunnel syndrome (CTS) is a common condition resulting from the compression or irritation of the median nerve as it travels through the carpal tunnel—a U-shaped channel formed by the eight bones of your wrist. This condition affects 3-5% of the general population, with women being two to three times more likely to develop CTS than men. It typically occurs in adults aged 45-60 and can significantly impact daily activities.

Causes and Risk Factors

Carpal tunnel syndrome is often brought on by activities that involve prolonged wrist flexion and repetitive wrist movements, such as:

  • Keyboard use
  • Supermarket scanning
  • Carpentry
  • Assembly line work

Other factors that can exacerbate CTS include exposure to vibration or cold temperatures. The condition is more common in the dominant hand but frequently affects both hands. Certain health conditions and lifestyle factors increase the risk of developing CTS, including:

  • Diabetes
  • Thyroid disease
  • Rheumatoid arthritis
  • Alcoholism
  • Kidney disease
  • Being short or overweight
  • Fluid retention during pregnancy

Symptoms of Carpal Tunnel Syndrome

Symptoms of CTS often start gradually and may include:

  • Numbness and tingling: Typically felt on the palm side of the thumb, index, middle, and half of the ring finger.
  • Discomfort: This can extend towards the elbow and usually begins as nighttime discomfort or waking up with numb hands.
  • Aggravation by gripping activities: Activities like reading, driving, or painting can worsen the symptoms.
  • “Shaking out” the hands: Early symptoms may be temporarily relieved by shaking the hands.
  • Sensation of tightness or swelling: Although there may be no visible swelling.
  • Hand weakness: In more severe cases, muscle weakness can develop.

CTS can also be part of “double crush syndrome,” where compression of the median nerve in the carpal tunnel is accompanied by compression at another site, such as the spine or muscles in the neck, shoulder, or forearm.

Chiropractic Care and Laser Therapy: Keys to Successful Treatment

1. Chiropractic Care:

Chiropractic adjustments are highly effective in treating carpal tunnel syndrome. Chiropractors can use specific manipulative techniques to alleviate the compression on the median nerve, thereby reducing pain and improving function. These adjustments not only address the wrist but also focus on the entire kinetic chain, including the neck, shoulder, and spine, which can contribute to the symptoms.

  • Alignment Restoration: By realigning the wrist and surrounding joints, chiropractic care helps relieve nerve pressure and enhance mobility.
  • Soft Tissue Therapy: Techniques like myofascial release can reduce muscle tightness and improve blood flow.
  • Ergonomic Advice: Chiropractors often provide guidance on posture and ergonomics to prevent further aggravation of CTS.

2. Laser Therapy:

Laser therapy is an innovative, non-invasive treatment that complements chiropractic care in managing carpal tunnel syndrome. It uses specific wavelengths of light to penetrate the skin and tissues, promoting healing and reducing inflammation.

  • Pain Reduction: Laser therapy helps decrease pain levels by reducing inflammation and promoting tissue repair.
  • Improved Nerve Function: By stimulating cellular activity, laser therapy can enhance nerve function and accelerate healing.
  • Non-Invasive: This treatment is painless and involves no downtime, making it an excellent option for those seeking non-surgical solutions.

Preventative Measures and Additional Treatments

  • Activity Modification: Avoid repetitive wrist flexion activities, such as push-ups and gripping handlebars on a bicycle, to prevent further irritation.
  • Splinting: A special wrist splint that holds your wrist in a neutral or slightly extended position can help alleviate nighttime symptoms.
  • Conservative Care: The American Academy of Neurology recommends conservative treatments like chiropractic care and laser therapy before considering surgical alternatives.

Conclusion

If left untreated, carpal tunnel syndrome can lead to permanent nerve damage. Early intervention with chiropractic care and laser therapy can effectively relieve symptoms and prevent long-term complications. If you’re experiencing symptoms of CTS, don’t wait—seek treatment and start your journey to recovery. Share your experiences or ask questions in the comments below. Let’s work together to keep our hands healthy and pain-free!

Trigger points in the scalenes muscles

~ bryancobb ~ Leave a comment

The scalenes muscles are located in the neck and help with neck movements and inspiration. The anterior scalene runs directly over the brachial plexus that gives nerve and blood supply to the arm. Poor neck and head posture as well as poor breathing mechanics can cause this muscle to become overloaded and develope trigger points. These points will refer pain into the shoulder, arm, and hand. As well as the shoulder blade. When tight, the anterior scalene muscle can put pressure on the brachial plexus causing numbness and tingling felt in the fingers and hand.

Brachioradialis trigger points and forearm and hand pain.

~ bryancobb ~ Leave a comment

The Brachioradialis muscle is located in the forearm. It is responsible for flexing the elbow in semipronation such as when lifting a coffee mug up to your mouth. Trigger points in this muscle are an often overlooked source of elbow pain. These points will also refer pain down the forearm and into the web of the thumb.

Trigger points in the scalenes

~ bryancobb ~ Leave a comment

The scalene muscles are located in your neck. They function to stabilize the cervical spine against lateral movement and elevate the first and second rib to assist inspiration. These muscles are often overloaded and develop trigger points from pulling, lifting, and tugging movements, prolonged cough due to illness, shallow breathing mechanics, and poor neck posture. Trigger points in these muscles can refer in two finger-like projections into the chest, other common patterns are into the shoulder, scapula and down the lateral arm, into the thumb and index finger. The scalene can impinge on the brachial plexus causing nerve pain or numbness down the arm. This is called thoracic outlet syndrome.