CTS

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

Chiropractic as THE alternative to Opioids.

~ Dr. Robert Speirs DC ~ Leave a comment

In 2015, two million Americans had a substance abuse disorder involving prescription pain relievers; with more than 20,000 overdose deaths related to these drugs. In the past decade, death rates and substance use rates quadrupled in parallel to sales of prescription pain relievers.

Chronic LBP is a primary generator for opioid prescriptions. This year, both JAMA and Annals of Internal Medicine have published and supported new clinical practice guidelines that recommend prescribing spinal manipulation over medication for LBP patients.

“For acute, subacute, or chronic low back pain, physicians and patients initially utilize spinal manipulation and delay pharmacologic management.”

Research shows that low back pain patients who undergo chiropractic care have improved outcomes with lower rates of opioid use, surgery, and overall healthcare costs.

Not surprisingly, various governing bodies, including the FDA, CDC, and 37 State Attorney General’s, have concurred that physicians and healthcare decision makers should consider non- pharmacologic therapy for LBP patients. In fact, the 2018 Joint Commission guidelines mandate that hospitals include conservative options for chronic musculoskeletal pain management, specifically naming chiropractic as a potential option.

Chiropractic care is not a replacement for traditional medical treatment of LBP, rather a complementary tool to integrate within your current management paradigm. We hope that you will continue to consider our office for those cases that may be favorably served by conservative manual therapy. We are grateful for your confidence and will work hard to maintain your trust.

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.

Can We Prevent Carpel Tunnel?

~ Dr. Robert Speirs DC ~ Leave a comment

Carpal Tunnel

 

Carpal tunnel syndrome (CTS) is the most common of the many “entrapment neuropathies”— nerve pinches in the arms or legs—likely because we use our hands and fingers repetitively for long time frames at work and during many of our hobbies. In addition, the wrist is a very complicated joint because it’s not a simple ball-and-socket or hinge, like the hip, elbow, or knee.

 
The wrist is made up of eight small “carpal” bones that are all shaped very differently and fit together a bit like a puzzle. These eight bones are lined up in two rows of four bones that form the “roof“ of the tunnel.

 
The shape of the tunnel changes with different activities, and the contents within the tunnel have to accommodate for this. Nine of the tendons that allow the hand to move the fingers also travel through the tunnel. Look at the palm-side of your wrist as you wiggle your fingers. See all the activity going on there? The median nerve travels through the tunnel as well, just under the “floor”, which is a very strong ligament that stretches from the pinky to the thumb-side of the tunnel.

 
Virtually ANY condition that increases the pressure inside the already tightly packed tunnel can create CTS symptoms like numbness, tingling, burning, etc. Over time, grip strength may weaken, causing one to accidentally drop objects.

 
To add to the causation list of CTS, conditions like obesity, pregnancy, diabetes, hypothyroid, rheumatoid arthritis (and other “arthropathies”), taking birth control pills (BCPs), and more can cause CTS without any increase in hand/wrist activities!
So HOW can we prevent CTS?

 

First, consider your job and your “workstation.” There are ergonomic keyboard and mouse options that can help you maintain a “neutral” wrist posture. If you have to bend your wrist a lot to do your work tasks—like placing items in a package, assembly work, etc.—see if you can change the angle of the package or assembly set up that allows your wrist to be straight, NOT BENT! Also, sit/stand up straight, chin tucked back, and DON’T SLOUCH!

 
A “night splint” forces the wrist to stay straight and can REALLY help! Managing your weight and health (manage your diabetes, thyroid, and medications that increase swelling like BCPs) is VERY important! There are also natural anti-inflammatory vitamins and herbs like ginger, turmeric, and bioflavonoid you may want to consider—your doctor of chiropractic can help you with this!

 
Chiropractors can manage CTS very well and can frequently help patients avoid the need for a surgical release. The “KEY” is to not wait—get treated early on!