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Can Carpal Tunnel Be Prevented? 

~ Dr. Robert Speirs DC ~ Leave a comment

​Prevent

Carpal Tunnel Syndrome (CTS) is a VERY common condition where the median nerve is compressed or squeezed as it passes through the wrist. One reason that it’s so common is because MANY daily activities require fast, repetitive use of the fingers, hands, and arms, and the friction of the rapidly moving muscle tendons inside the tunnel results in swelling and compression of the nerve. So, can CTS really be prevented?

There are many factors associated with CTS, and some risks can be prevented. For example, some conditions like diabetes, rheumatoid arthritis, and IBS increase the risk of CTS. Therefore, it would be safe to assume those who better manage such conditions would have a lower risk for developing CTS.

Due to the many factors associated with CTS, there is no “one size fits all” when it comes to treatment and prevention of CTS. With that said, here are some VERY effective methods:

1)  Ergonomic workstation modifications: Altering the work space (monitor height, keyboard/mouse style, different chair, chair/desk height, etc.) to reduce the number and speed of movements needed to perform commons work tasks.

2)  Rest periods: Insert “micro-breaks” into a busy task. Combine breaks with stretching exercises of the wrist/hand/fingers and vary job tasks between fast and slow repetitive types.

3)  Exercise: Shake the fingers and hands, lean back in a chair with the arms/shoulders stretched back (“Brugger’s Exercise”), move the neck (chin tucks, rotations, etc.), bend the hand/wrist backwards on a wall or the desk’s edge, self-massage and deep tissue release of the forearm and hand muscles. Do regular aerobic exercise (walking, swimming, biking, etc.) several times each week.

4) Posture: Sit up straight, elbows about 90° on height-adjustable arm rests or comfortably at the sides, forearms parallel to the floor; knees level or slightly lower than the hips, feet flat on the floor or on a footrest or box, if needed. Place typing materials at eye level / avoid prolonged head/neck rotation. Use a wrist rest for the keyboard and mouse, and use a headset when on the phone.

5)  Reduce hand tool forces: Choose a tool that allows the wrist to remain neutral. Avoid side to side and flexion/extension wrist positions—especially if they’re prolonged! Tool handles should NOT dig into the palm of the hand or the wrist, and should not have sharp edges. A textured handle can improve grip. Minimize vibration from power tools. Wear shock absorbing gloves. Avoid cold work environments and cold tools.

6)  Diet: Cut down on caffeine and smoking. Avoid obesity—a known risk factor of CTS! Consider an anti-inflammatory diet (Paleo, Mediterranean).

7)  Splints: A wrist cock-up splint at night prevents prolonged faulty positions and REALLY helps!

This is a partial list of preventative measures that can REALLY help. Doctors of chiropractic treat the WHOLE person and can teach you the right exercises, ways to modify your diet, offer manual therapies and modalities, and help guide you in your self-management of CTS, as this can be a lifelong affliction. A multi-modal treatment approach generally works best!

Is Surgery Always Required?

~ Dr. Robert Speirs DC ~ Leave a comment

​Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy—that is, it’s the most common place to trap a nerve in the extremities (arms or legs). CTS affects 6-11% of adults in the general population, and it occurs in women more often than men. The cause is often difficult to determine but the most common reasons can include trauma, repetitive maneuvers, certain diseases, pregnancy, being over the age of 50, and obesity.

So, is surgery the only answer? The short answer is NO! In fact, in a recent randomized clinical trial published in the Journal of Pain, researchers observed similar improvements in function when they compared the outcomes of patients who underwent surgery vs. those who received manual therapies (such as those performed several times a day at chiropractic clinics around the world) at both six months and one year later. The improvements included increased strength, function, and decreased hypersensitivity in both the surgical and non-surgical groups. Interestingly, the manual therapy group did BETTER at the one and three month assessments when compared with the surgical group (again, with no difference at six and twelve months)!

The median nerve, the culprit behind CTS, starts in the neck and travels down through the shoulder, elbow, forearm, and finally through the carpal tunnel, which is made up of eight small carpal bones that form the arch of the bridge. Entrapment of the median nerve occurs when the normally tight quarters within the carpal tunnel combine with the inflamed nine sheathed muscle tendons that push the nerve into the floor of the tunnel (a ligament), which results in CTS! The goal of therapy—both surgical and manual therapy—is to reduce the pressure within the tunnel and free up the compression of the median nerve.

Manual therapies focus on joint mobilization and manipulation to reduce joint fixations, muscle release techniques in the forearm and hand, stretching techniques, and at-home exercises that emphasize a similar stretch, the night brace, and management of any underlying contributing factor. These “underlying factors” might include diabetes, hypothyroid, taking birth control pills, weight management, and inflammatory arthritis.

 

CTS SUrgery

Do you have Carpal Tunnel Syndrome?

~ Dr. Robert Speirs DC ~ Leave a comment

​Carpal Tunnel Syndrome is VERY common. If fact, it affects 3-6% of the general population, and up to 50% of those afflicted have it in both hands! So what makes it so common? Here are several reasons:

1) ANATOMY: The wrist is made up of eight small “carpal” bones that allow the wrist to bend and twist in many different positions. If you were to look at the wrist “head on,” you’d notice it is shaped like a tunnel where the eight little carpal bones make up the “roof” and the transverse carpal ligament is the “floor.” You’ll also notice nine tendons and their sheaths that pass through the carpal tunnel and attach the forearm muscles to the fingers on the palm side of the arm, blood vessels, and the median nerve. When there is less available space within the carpal tunnel (due to inflamed tendons, for example), the added pressure can compress the median nerve and result in numbness, tingling, and weakness, mostly into the second to fourth fingers.

2) JOBS: People with occupations that require fast, repetitive movements and/or a firm grip with little rest have a higher likelihood of developing CTS.

3) GENDER: Women have a greater risk of developing CTS than men due to smaller wrists and hormonal changes that may result in swelling in the wrist.

4) AGE: Individuals over age 50 have a greater risk of developing CTS, especially females.

5) GENERAL HEALTH ISSUES: There are a host of conditions that can cause and/or aggravate CTS. Some of these include rheumatoid arthritis, diabetes, osteoarthritis, low thyroid function, and space-occupying issues like a ganglionic cyst inside the tunnel. Certain medications, such as birth control pills, and some forms of chemotherapy can also cause CTS. A pinched nerve in the neck or shoulder can alter median nerve function, which can exacerbate CTS symptoms.

6) TRAUMA: A fall onto an outstretched arm can sprain and/or fracture the wrist. If a fracture occurs, the onset of CTS can be very rapid, and quick realignment of the fracture is very important.

Chiropractic care offers a non-surgical solution to CTS, which includes splinting (primarily at night and when driving but usually less often during the day as we tend to “fight” against the splint), anti-inflammatory measures (ice, nutrients such as ginger, turmeric, bioflavonoids), and manual therapies—manipulation of the fingers, hand, wrist, elbow, shoulder, and neck (as indicated) and muscle release techniques to the forearm are very helpful. There are also effective exercises that patients can do at home that include joint range of motion and muscle stretching techniques.

 

Shrug

Why do so many suffer with CTS?

~ Dr. Robert Speirs DC ~ Leave a comment

​According to the literature, carpal Tunnel Syndrome (CTS) is one of the most prevalent upper extremity complaints. In fact, it IS the most common “compression neuropathy” (of which there are many) and affects 3-6% of adults in the general population. Additionally, CTS can affect BOTH hands in up to 50% of patients with the condition!

The CAUSE of CTS is often unknown and typically comes on gradually, making it difficult to determine a definite cause or specific “date of onset” for CTS.

Symptoms such as numbness, tingling, loss of dexterity, loss of strength (like pinch or grip), and the need to shake the hand or flick the fingers to restore sensation are ALL VERY COMMON CTS SYMPTOMS. The REASON for these symptoms boils down to one thing: The median nerve in the wrist gets pinched! The cause/s can include:

1)  Repetitive motion from either work or hobbies like assembly line work or playing a musical instrument can cause swelling within the carpal tunnel, placing extra pressure on the median nerve as it passes through.

2)  Obesity can contribute to CTS due to extra fluids or fatty deposits that can build up within the carpal tunnel.

3)  Pregnancy: Elevated levels of the hormones estrogen and progesterone can cause the body to retain fluids and increase pressure in the carpal tunnel.

4) Arthritis: Osteoarthritis can lead to CTS (such as when a spur forms inside the tunnel). Rheumatoid arthritis can lead to an autoimmune response and antibodies that end up attacking the cartilage of the joints in the wrist, which can lead to CTS.

5)  Hormone-related conditions: In diabetes mellitus, the blood becomes thicker due to high sugar levels (like syrup) and can’t pass through the small blood vessels, resulting in “neuropathy,” which can make CTS more likely. In hypothyroid, low thyroid function results in “myxedema,” a specific type of swelling that makes CTS more likely to occur.

6)  Trauma: A wrist fracture could cause the carpal tunnel to “collapse” or change in shape resulting in less space for the nerve to travel through.

7)  Mass lesions: A “ganglionic cyst” is a good example. This is where joint fluid leaks out and forms a “bump” on the INSIDE the carpal tunnel, which reduces space and increases pressure in this anatomical structure.

8)  Amyloidosis: This is a rare condition where a protein substance called “amyloid” builds up in any tissue or organ. If this occurs in the wrist, it can “pinch” the median nerve as it passes through.

9)  Sarcoidosis: This is the growth of small collections of inflammatory cells called “granulomas,” which can accumulate in different parts of the body. If it occurs in the wrist, pinching can occur.

10)  Multiple Myeloma: This is a type of cancer that affects the bone marrow, and inflammation in the wrist can occur creating the pressure increase on the median nerve that can lead to CTS.

11)  Leukemia: This too is a type of cancer that involves the white blood cells, and CTS can result from its effects on the tissues in the wrist.

12)  Anatomy: The size and shape of the carpal tunnel is hereditary, and some of us have a smaller tunnel than others. If CTS is present in multiple family members, this “genetic” factor may play a role.

There are other conditions that can “mimic” CTS, but doctors of chiropractic are trained to perform an accurate history and examination so treatment can be directed in the proper manner!

A Few Sleep Tips From Us To You

~ Dr. Robert Speirs DC ~ Leave a comment

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Your mattress and the position you sleep in may affect your spine.

✓ Choose a mattress that provides medium or firm support, such as a traditional coil spring or adjustable airbed. Avoid waterbeds, thick pillow tops and soft, sagging mattresses.
✓ Always sleep on your back with a pillow either underneath your knees or on your side with a pillow between your knees. Avoid sleeping on your stomach.
✓ Keep your neck and back covered while sleeping to avoid drafts that could cause potential muscle spasms.

Here are a couple of tips to help you get in and out of bed more comfortably:
✓ To lie down: Sit on the edge of the bed, pull your arms to your sides and tilt your body into the bed, maintaining the bend of your knees at 45 degrees. Finally, bring your feet into in a lying position or roll onto your back.
✓ To get up: From a side-lying position with your knees bent, push your body upright into a sitting position, swinging your legs over the edge of the bed as you rise.

If you find that you wake up sore then you may be suffering from any number of conditions that get worse overnight.

Carpal Tunnel Facts #1

~ Dr. Robert Speirs DC ~ Leave a comment

​If tingling/numbness primarily affects your thumb, index, third, and ring fingers, it very well could be carpal tunnel syndrome, or CTS. Chances are you’ve probably had this condition for months or even longer but it’s been more of a nuisance than a “major problem” and therefore, you probably haven’t “bothered” having it checked out. Let’s take a look at some “facts” about CTS!

WHAT IS CTS? CTS is basically a pinched nerve (the median nerve) that occurs on the palm side of the wrist that innervates the three middle fingers and the thumb on the palm side. This nerve starts in the neck, runs through the shoulder to enter the arm, and travels down the palm side forearm through the carpal tunnel. The carpal tunnel is made up by eight small bones (called “carpal bones”) that form the roof and walls of the tunnel. The floor of the tunnel is a ligament called the transverse carpal ligament. The median nerve lies immediately on the floor, and deeper inside the tunnel are nine tendons that connect the muscles of our forearm to the fingers, which allow us to make a fist and grip. When swelling occurs inside the tunnel, the nerve is pinched against the floor (ligament) and symptoms occur.

SYMPTOMS OF CTS: Symptoms typically start gradually with tingling, numbness, burning, itching, or a “half-sleep” feeling in the palm of the hand, thumb, and middle three fingers. The fingers can feel swollen and weak, though “swelling” is usually NOT visible. CTS can occur in one or both hands, but it is usually worse in the dominant hand. Initially, you may only notice symptoms at night or in the morning. As CTS worsens, sleep interruptions, grip weakness, difficulty distinguishing hot from cold, increased pain, pain radiating up the arm, and more may occur.

CAUSES OF CTS: There are many causes of CTS that often occur in combination: 1) Heredity or genetics — being born with a smaller wrist than others; 2) Trauma — a fall on the arm/hand (sprain or fracture); 3)  Overuse of the arms/hands (like repetitive line work, serving tables, or using a computer), 4) Hormonal causes — during menstruation, with pregnancy, during menopause, diabetes, hypothyroid, overactive pituitary gland; 5) Rheumatoid arthritis; 6) Fluid retention; 7) Cysts, tumors, or spurs inside the tunnel; 8) Vibrating tools, 9) Hobbies such as knitting, sewing, crocheting; 10) sports; or 11) an “Insidious” or unknown cause!

CTS RISK FACTORS: 1) Gender: Women are three times more likely to develop CTS, possibly because they generally have a smaller carpal tunnel than men, in addition to hormonal differences; 2) Diabetes or other metabolic disorders; 3) Adults, especially >50 years old; 4) Job demands.

CTS DIAGNOSIS: Your doctor of chiropractic will review your patient history and then evaluate the neck, shoulder, arm, and hand, as ALL can be involved in producing CTS-like symptoms. He/she may also order blood tests (to check for diabetes, thyroid levels, rheumatoid arthritis, etc.) and/or an EMG/NCV (electromyogram/nerve conduction studies) to test for nerve damage.

We will FINISH THIS interesting discussion next week covering: Treatment, prevention, and research.

Facts