Carpal Tunnel Syndrome
Causes, Treatments & Prevention
Carpal tunnel syndrome (CTS) is a problem of the median nerve, which runs from the forearm into the hand. CTS occurs when the median nerve gets compressed in the carpal tunnel, a narrow tunnel at the wrist made up of bones and soft tissue. Nerves, tendons, and blood vessels travel through this tunnel, which when compressed may result in pain, weakness and/or numbness in the hand and wrist, radiating into the forearm.
Patients with Carpal Tunnel Syndrome are common at IPM. We take a well-rounded approach to each and every assessment and treatment. CTS typically occurs in adults, with women three times more likely to develop it than men. The dominant hand is usually affected first, and the pain is typically severe. CTS is especially common in people who do repetitive motions for extended periods of time, such as factory work or typing.
No referral necessary.
What Are The Causes of CTS?
Some people have smaller carpal tunnels than others, which makes the median nerve compression more likely. In others, CTS can develop because of an injury to the wrist that causes swelling, overactivity of the pituitary gland, hypothyroidism, diabetes, inflammatory arthritis, mechanical problems in the wrist joint, poor work ergonomics, repeated use of vibrating hand tools, and fluid retention during pregnancy or menopause.
How Is CTS Diagnosed?
CTS should be diagnosed and treated early. A standard physical examination of the hands, arms, shoulders and neck can help determine if your symptoms are related to daily activities or to an underlying disorder. Your doctor or one of our IPM providers can use other specific tests to try to produce the symptoms of carpal tunnel syndrome.
The most common Carpal Tunnel Syndrome tests are:
Pressure-provocative test: A cuff placed at the front of the carpal tunnel is inflated, followed by direct pressure on the median nerve.
Carpal compression test: Moderate pressure is applied with both thumbs directly on the carpal tunnel and underlying median nerve at the transverse carpal ligament.
Laboratory tests and x-rays can reveal diabetes, arthritis, fractures and other common causes of wrist and hand pain. Sometimes electrodiagnostic tests, such as nerve conduction velocity testing, are used to help confirm the diagnosis. With these tests, small electrodes placed on your skin measure the speed at which electrical impulses travel across your wrist. CTS will slow the speed of the impulses and will point your chiropractor to this diagnosis.
How Can CTS Be Prevented?
We suggest to our patients the following CTS prevention strategies:
- Perform on-the-job conditioning, such as stretching and light exercises.
- Take frequent rest breaks, especially when at a computer.
- Wear splints to help keep the wrists from going into flexion.
- Use fingerless gloves to help keep the hands warm and flexible.
- Use correct posture and wrist position.
To minimize workplace injuries, a rotation of jobs among workers can help. Employers can also develop programs in ergonomics, which is the process of adapting workplace conditions and job demands to workers’ physical capabilities.
What Are the Symptoms?
Burning, tingling, itching and/or numbness in the thumb, index and middle fingers are common CTS symptoms. Some people with CTS say that their fingers feel useless and swollen, even though little or no swelling is apparent. Since many people sleep with flexed wrists, the symptoms often first appear while sleeping. In severe cases, the muscles of the palm area will atrophy.
As symptoms worsen, people may feel tingling during the day. In addition, weakened grip strength may make it difficult to form a fist or grasp small objects. Some people develop wasting of the muscles at the base of the thumb. Some are unable to distinguish hot from cold by touch.
What Is the Treatment for CTS?
Initial Carpal Tunnel Syndrome therapy includes:
- Resting the affected hand and wrist.
- Avoiding activities that may worsen symptoms.
- Immobilizing the wrist in a splint to avoid further damage from twisting or bending.
- Applying cool packs to help reduce swelling from inflammation.
Some medications can help with pain control and inflammation. Studies have shown that vitamin B6 supplements may relieve CTS symptoms.
Joint manipulation and mobilization of the wrist and hand, stretching and strengthening exercises, soft-tissue mobilization techniques, and even yoga can be helpful. Studies have also shown that other therapies, such as acupuncture, may help treat and manage symptoms of this disorder.
Occasionally, patients whose symptoms fail to respond to conservative care may require surgery. The surgeon will release the ligament covering the carpal tunnel. Guidance on posture and movement, as instructed by your IPM provider, can also help prevent CTS recurrences.
Do You Have Carpal Tunnel Syndrome?
If you are in pain or are interested in finding out more, contact us to make an appointment. No referral necessary.