Carpal Tunnel Syndrome – Why is it so common?

Carpal tunnel syndrome or, CTS, is a condition where a nerve (called the median nerve) is compressed in a relatively tight or restricted space (called the carpal tunnel), resulting in altered nerve function that includes numbness and weakness.  In order to fully understand what CTS is, let’s devote this Health Update to better understanding the anatomy of the carpal tunnel.

The carpal tunnel is made up from 8 bones (2 rows of 4 carpal bones that are stacked on top of each other) that are arranged in the shape of a horse shoe.  The “roof” of the tunnel is a ligament (transverse carpal ligament) that stretches tightly across the two ends of the horseshoe completing the formation of a tunnel – actually, an upside down tunnel when looking at the palm side of the wrist).  The contents of the tunnel include 9 tendons and their covering (sheath), blood vessels and on top of all that just under the roof is the median nerve – the culprit that creates most of the symptoms of CTS.  The cause of CTS is simply anything that causes the contents inside the tunnel to swell, which then compresses the median nerve up into the roof or ligament, pinching the nerve. This can create numbness, tingling, the falling asleep sensation and weakness.  It’s important to point out that the median nerve starts out from the neck, passes through the shoulder, past the elbow, through the wrist’s carpal tunnel and ends in the hand – specifically fingers 2,3, and 4.  Therefore, the ENTIRE nerve must be looked at for all CTS cases as pinching can occur anywhere along its course from the neck to the hand.

It’s said that pictures say a thousand words, so let’s take a look!

Using the pictures here, familiarize yourself with the words and re-read the 2nd paragraph above, periodically looking at these pictures until you feel you understand where everything goes.  Once you’ve accomplished that, you’ll be able to better appreciate CTS, how the anatomy relates to the condition, and appreciate the need to reduce the swelling inside the tunnel when symptoms occur.  The treatment is simple: “PRICE” – P protect R rest I ice C compress E elevate – accomplished by bracing (especially at night), ice cup massage (5 min. until numb 5x/day), rest (light duty work), and therapy (see your chiropractor!).

We realize that you have a choice in who you are considering 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 require care for CTS, we would be honored to render our services.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR CARPAL TUNNEL SYNDROME!  FOR MORE INFORMATION LOG ON TO WWW.RELIEFFROMCARPALTUNNEL.COM

Exercises For Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a common condition resulting in hand and sometimes neck and arm complaints.  This can include numbness or tingling in the fingers, leading to dexterity problems such as difficulty buttoning clothing or picking up small objects.  There are also issues with strength loss / weakness noticed such as when turning door knobs, opening jars, and even problems with turning the key to start a car. One big problem with CTS is people often wait too long before having it treated thinking it will “…go away” or disappear just like it started.  CTS rarely gets better without some form of treatment and seeing a chiropractor makes perfect sense prior to considering surgical intervention.

So, the question remains, “what can I do for CTS?”  There are several things a CTS sufferer can do to help manage this condition.  Some risk factors such as gender and age cannot be changed but other factors can be changed including taking “mini-breaks” throughout the work day and/or work station modifications, managing weight as obesity (defined as a BMI >30 and a waist size >35” for women and >40” for men), wearing a wrist splint, as well as performing exercises to stretch the wrist area.

A study out of the University of Oklahoma reported 2 out of 3 patients with mild to moderate CTS avoided surgery by performing specific exercises.  The concept of a 5-minute warm-up stretch each day before starting the workday is similar to a runner stretching before a run to prevent injury.

Step A:  Extend and stretch both wrists and fingers acutely as if they are in a standing push-up position. Hold for a count of 5.
Step B:  Straighten both wrists and relax fingers.
Step C:  Make a tight fist with both hands.
Step D:  Then, bend both wrists down while keeping the fist. Hold for a count of 5.
Step E:  Straighten both wrists and relax fingers, for a count of 5.
Step F:  Then, let your arms hang loosely at the side and shake them for a few seconds.

This exercise should be repeated 10 times and can be repeated several times a day.

Chiropractic is a perfect choice when considering a health care provider for the treatment of CTS as these exercises can easily be taught to you at our office.  In addition, many other non-surgical treatment options for CTS are available.

We realize you have a choice in who 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 require care for CTS, we would be honored to render our services.

YOU MAY BE A CANDIDATE FOR NON_SURGICAL TREATMENT FOR CARPAL TUNNEL SYNDROME!  Log on to www.relieffromcarpaltunnel.com

Carpal Tunnel Syndrome After a Car Accident

One of the common injuries that happen in a car accident is carpal tunnel syndrome (CTS).  CTS is a condition that causes pain or numbness in the first three fingers of the hand.  You can get it anytime you have swelling in the wrists, that compresses the median nerve.

Usually the swelling is caused by repetitive motions like computer work, assembly work or even knitting.  The overuse causes the tendons in the wrist to swell until they compress the nerve.

However, the wrists can also swell as the result of a car accident.  If your hands were on the steering wheel, at the time of impact, they can be jammed, injuring the wrists and causing them to swell.  This can cause carpal tunnel syndrome.

Also, if the neck is injured, the median nerve can get irritated where the nerve fibers exit between the bones of the neck.  This injury will cause the same symptoms as CTS, without the wrists being injured.

It is important to have your wrists, arms and neck evaluated if you have pain or numbness after a car accident.  Pain relievers and muscle relaxants do not properly treat these injuries.  They can easily become chronic if not treated correctly.

For more information on CTS treatment, log on to www.relieffromcarpaltunnel.com.  More information on car accident related injuries can be found at www.thechiropracticimpactreport.com

We Have Been Treating Carpal Tunnel Syndrome (CTS) since 1995.

It wasn’t that long ago that patients would look at me strange when I suggested that the source of CTS symptoms is usually in the neck (conditions such as vertebral subluxations, cervical disc bulges and herniations, disc degeneration, facet syndrome, spinal stenosis, and forward head posture).

I used to hear something like this every day…”The pain is in my hand…why are you checking my neck?”

My fellow doctors, my patient’s primary doctors, my wife…everyone thought this was a little strange…that is until they witnessed the results we were getting treating carpal tunnel patients from the neck down to the fingertips.

The reason seems obvious now…now that it is almost a form of malpractice not to consider pathology in the neck when it comes to diagnosing and treating CTS symptoms.
WHY? Because the nerves that innervate or connect and control the arm and hand originate in the neck. And pressure on these nerves in the neck causes the same signs and symptoms as true carpal tunnel syndrome.

The nerve involved is CTS is called the median nerve. The median nerve originates in the neck. It is formed by branches of nerve roots from C5-C8 (C=cervical) which is the lower part of your neck. You have 7 bones in your neck (cervical spine)…and nerves exit from the left and right (underneath) of each bone. These nerves connect and form the 3 major nerves that control the arm and hand. The median nerve, the radial nerve, and the ulnar nerve.

The median nerve (named median because it travels down the middle of the arm) travels through an area of bones and ligaments in the wrist called the carpal tunnel, where it is susceptible to pressure from either the contents of the tunnel expanding (nerves and tendons from inflammation and overuse, repetitive stress injuries-RSI) or the diameter of the tunnel contracting (bones out of alignment from poor ergonomics, trauma, degeneration, and congenital defects, tumors). If either of these situations occur it can put pressure on the median nerve causing clinical CTS. In fact, by definition CTS is median nerve compromise in the carpal tunnel. True CTS is rare.

Again (and this can be hard to grasp)…pressure on the nerves in the neck that form the median nerve causes the same symptoms (in the hands) as CTS when they have pressure on them. Here are the most common symptoms:

• Pain in the arm and hand or hands
• Numbness and Tingling in the arms and hands
• Weakness of grip
• Night pain in the hand/s
• Burning sensations in the hand
• Clumsiness of hand/s
• Neck pain
• Shoulder pain
• Swelling of the hand

So how do you know if you have CTS or if the problem is in the neck? You don’t…you have to be checked by an expert to find out. A doctor that spends the majority of their day treating patients with neck, shoulder, arm and hand pain.

And…just because your doctor may correctly identify your carpal tunnel symptoms cause as originating the neck…it does not mean they know what to do about it.

My treatment approach is to work from the neck to the fingertips on both sides. We also address the entire spine because the spine functions as a unit. Heck…you could even have a problem in your leg that is causing imbalances in the spine, leading to nerve pressure in the neck, resulting in CTS symptoms in your hand. Strange but true.

This is why so my people with hand pain find it hard to get the right kind of treatment and end up in a viscous circle of diagnostic testing, cortisone, pain pills, crazy treatments, and even surgery.

Anyway…the bottom line is this. If you have CTS symptoms you need to find yourself a doctor that not only can diagnose CTS and it’s related disorders…but that also has a proven method of treatment. This is often times not easy.

In any case…don’t just head to the operating table or give up on getting better. It may be that you just have not found the right doctor…a doctor that knows CTS, and the CTS-cervical spine connection…and how to treat it.

To schedule a complimentary CTS evaluation with me, Dr. Paul Kramer call Jennifer at 262-251-8306 or visit us online at www.relieffromcarpaltunnel.com or visit my practice web-site at www.painfree-greatposture.com.

Carpal Tunnel Syndrome (CTS) – Can It Be Prevented?

Carpal Tunnel Syndrome or CTS is a very common problem affecting many workers and is one of the most costly conditions afflicting today’s workforce.  It is most often caused by repetitive activity using rapid movements of the arms and hands and can lead to work loss and disability when not properly managed.  CTS occurs when the median nerve that travels through the carpal tunnel (CT) located on the palm side of the wrist becomes pinched by the swelling of the 9 tendons that also travel through the CT and essentially, pinch the nerve up against the transverse carpal ligament.  This results in numbness, tingling and/or pain of the index, middle and forth fingers.

Other symptoms include sleep interruptions where shaking and flicking of the fingers is required to allow for a return to sleep.  This is frequently caused by sleeping with the wrist in a cocked position, increasing the pressure inside the already swollen carpal tunnel.  This is why a cock-up wrist splint usually helps as it disallows the wrist from bending to the extremes and the nerve is not pressured or pinched as much.  Other symptoms include weakness of the grip, making it a challenge to unscrew a jar, open a door, and even sometimes turn the key when starting a car.  Driving can also be affected as the hands often fall asleep while holding onto a steering wheel.

Pain can also affect the rest of the arm and sometimes the neck area.  The median nerve can also be pinched in more than one place and may include the neck, shoulder, elbow as well as the wrist making it necessary to have all the areas treated for a satisfying result.

People at greatest risk are women > men, workers who handle small tools, computer workers, fast repetitive line workers, and people older than 40 years of age.  People with other health conditions including rheumatoid arthritis, Lymes disease, rubella, pregnancy, birth control pill use, diabetes mellitus and menopause are at an increased risk of developing CTS.  Certain foods such as caffeine, tobacco, and/or alcohol may also contribute to CTS.

Though treatment is very important –the sooner the better- prevention is most important.  In fact, some simple approaches can make a big difference!  Some of these include modifying the position of a computer chair, keyboard, monitor, or mouse (work station modifications), alternate between different tasks to reduce the repetition of work, stretch your forearms and fingers before, during and after work, and treat any underlying conditions.  When symptoms first occur, these recommendations, as well as wearing a night wrist cock-up splint and seeing your chiropractor, will often reverse the condition without difficulty.  If you wait too long and nerve damage occurs, it becomes a more challenging process to manage CTS and at times, even surgery will not be very helpful.

Some of the non-surgical treatment approaches you might expect from your chiropractor include joint manipulation and/or mobilization applied to the neck, wrist, elbow and/or shoulder, the application of physical therapy modalities such as ultrasound, electrical stim, and/or low level laser therapy (“light” therapy), as well as the use of wrist splints.

The University of Maryland Medical Center cites two research articles on chiropractic treatment for CTS. They report good results are usually obtained and that these good results continued for at least 6 months after treatment ended.  The same reference also recommends nutrition and supplements in the management of CTS.  Some of these include: eliminate food allergens (often milk, cheese, eggs, ice cream, glutens/wheat-grains, soy, corn, and preservatives) and eating foods high in B-vitamins (dark leafy greens like spinach, kale, and sea vegetables), anti-oxidants (fruits – blueberries, cherries, tomatoes; vegetables – squash, bell peppers),  avoiding refined foods, using olive oil and adding omega 3 fatty acids to the diet (fish oil).  Other vitamins including a multivitamin, B complex, Vit. C, alpha-lipoic acid, MSM, resveratrol, Vit. D, Co-Q10, magnesium can also really help.

We realize that you have a choice in where you choose for your healthcare services.  If you, a friend or family member requires care for CTS, chiropractic care is a logical first choice and we would be honored to offer our services to you.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR CARPAL TUNNEL SYNDROME!  FOR A FREE NO-OBLIGATION CONSULTATION CALL 262-251-8306

Carpal Tunnel Syndrome (CTS): What Are My Options?

Carpal Tunnel Syndrome or CTS, has been reported to be the most expensive of all work-related injuries, costing the average CTS patient about $30,000 in medical bills and lost work time over his or her lifetime. CTS is primarily found in adults, is 3x more frequently found in woman, and usually affects the dominant hand first.  The pain can be quite severe and disabling. Certain occupations tend to cause CTS more than others, such as manual labor jobs (assembly-line / manufacturing, sewing, finishing, cleaning, meatpacking, food processing and packing occupations). Other jobs like computer work, playing a musical instrument and waitressing can also cause CTS.  Certain medical conditions such as diabetes, obesity, pregnancy, the use of birth control pills, inflammatory arthritis and hypothyroidism can predispose patients to CTS.  CTS is caused by a pinch to the median nerve that runs down the arm from the neck, through shoulder, elbow and wrist. The pinch can occur in one or more of these locations making it important to obtain a complete evaluation including the neck and upper arm – not just the wrist.  There are a total of 9 tendons, ligaments, and blood vessels jammed into the tight confines of the carpal tunnel formed by 8 small carpal bones and the transverse carpal ligament that serves as the “roof” of the tunnel.  Symptoms include burning, tingling, aching, and/or numbness primarily into the 2nd to 4th fingers and at times, the thumb. Some sufferers develop weakness in their grip making it hard to open jars, stubborn door knobs, holding onto a newspaper or steering wheel.  Waking up multiple times at night is also a common complaint caused by sleeping with the wrist bent, which increases the pressure inside the tunnel, thus pinching the nerve more firmly.

A CTS diagnosis is made by reproducing the symptoms by further compressing the median nerve inside the tunnel.  This is accomplished by applying pressure over the tunnel, by bending the patient’s wrists 90 degrees backwards (dorsiflexion) and forwards (palmar flexion), compression over the proximal forearm, at the thoracic outlet (under the collar bone) and / or at the neck.  Special tests like an EMG/NCV (electromyogram and nerve conduction velocity) can determine the degree of nerve damage and verify the diagnosis.  At times, x-ray or MRI are helpful if arthritis or a bone spur is suspect, or to measure the size of the carpal tunnel.  Laboratory blood tests to determine secondary causes, described earlier, can also be of benefit.

Treatment consists of 1. Rest; 2. Modifying the activity or workstation suspected of causing CTS; 3. Using a splint- especially at night and when driving; and 4. Managing any underlying disease condition. Managing inflammation is also important, which can be accomplished by the use of ice of. (Ice massage is very effective.  This consists of freezing water in paper cups, tearing off the top half of the cup, and rubbing the ice against the skin for approximately 5 minutes.  The sequence of sensations includes cold, burning, aching, and numbness (“C-BAN”). Make sure you quit when numbness is reached, as frost bite is a risk if performed for too long.)  Anti-inflammatory medications like ibuprofen, naproxen, or herbal remedies such as ginger, turmeric, boswellia, and/or vitamins like bromelain & papain, vitamin B6, fish oil (omega 3 fatty acids, Vitamin D (2000-5000IU); calcium/magnesium are all potentially helpful. Manual manipulations to the joints of the neck, shoulder, elbow, wrist and hand and soft tissue manipulation to the muscles and tendons of the forearm and hand can also be used.  Other non-surgical treatments include exercises and physical therapy modalities such as low level laser therapy, electrical stimulation, ultrasound, and others.

We realize you have a choice in where you choose for your healthcare services.  If you, a friend or family member requires care for CTS, chiropractic care is a logical first choice and we would be honored to offer our services to you.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR CARPAL TUNNEL SYNDROME! For more information log on to www.relieffromcarpaltunnel.com

What Is The Carpal Tunnel Whiplash Connection?

Carpal tunnel symptoms typically come on slowly. Day after day we are able to type at the computer with no problem and then one morning a little tingling in the fingers develops. We shake our hands, stretch the fingers, and try to go back to the keyboard. But inevitably the tingling continues and seems to worsen as we try to do our work.

Why does this occur? Why are we fine one day, and the next we have disabling pain that interferes with our ability to work? This can be very distressing psychologically and many patients with carpal tunnel symptoms show signs of depression.

So what was the event that triggered the problem? A chiropractic or medical doctor may ask about a trauma to the wrist bones but most patients will not say they suffered an accidental injury. Often times, both hands seem to be affected and trauma is usually seen when landing on one wrist, with symptoms following within minutes or days of the event.

But carpal tunnel is much different. The symptoms come on slowly and out of nowhere. Typing is fine one day, and the next we cannot complete our work at the keyboard.

Carpal tunnel symptoms come from the nerves that pass through the wrist. Those nerves begin in the neck, cross the shoulder and go down the arm before entering the carpal tunnel that is formed by the bones in the wrist.

Typing is not a traumatic motion for the fingers and the hand. One has to look at other potential areas where the nerves travel. These areas can become traumatized from accidents. The neck is especially vulnerable to trauma from car accidents and sports injuries. The delicate ligaments and discs of the neck can be injured when the head is whipped around from trauma.

Unfortunately when we type, the neck is usually in a forward bent position, especially if the typist has to look at the keyboard while working. If the computer user is in this position for many hours during the day, the nerves can eventually become stretched, producing pain, tingling and numbness. If those same nerves were traumatized from a whiplash injury, forward head position alone can be enough to bring on symptoms. This is why it is important that a doctor looks at more than just the wrist areas when examining the patient.

When the low back is injured, leg pain or sciatica can result. The problem is rarely caused by a problem in the leg. Carpal tunnel symptoms act the same way. If your carpal tunnel symptoms don’t seem to respond to wrist treatments, consult a chiropractor who will do a detailed examination of all areas that could be causing the problem, especially the neck. Tell the doctor about any traumas to the spine you may have suffered in the past. Injuries from even decades earlier can be the hidden cause of your problem and are very significant.

YOU MAYBE A CANDIDATE FOR RELIEF.

For More Information log on to: www.relieffromcarpal tunnel.com

Carpal Tunnel Syndrome In Your Neck?

Over the decades we have come to expect that a pain or tingling in the hand and wrist means there is a local injury in the area. Since many surgeries are done each year on the wrist to relieve these symptoms, it seems logical that this is the case. But many patients with “successful” surgeries still have problems over time. Others get only temporary relief and the problem quickly returns. Other patients can develop wrist and hand symptoms that mimic carpal tunnel syndrome, after a whiplash injury or sprain/strain of the neck. These patients may not have any trauma at all to the wrist and hand area but have severe hand pain. Why does this occur?

One possibility is that the carpal tunnel diagnosis was incorrect. Because your body is interconnected with joints and nerves, symptoms often occur at another location from that of the actual problem. Taking this approach is more holistic, vs. the often-fragmented medical view of things. We have doctors of the feet, the eyes, and various other body parts. These types of specialists, while often good at specific problems, can sometimes miss diagnoses that are complex and involve multiple body systems.

More and more research has shown this to be the case in carpal tunnel patients. A study from 2006 looked at the spines of patients with carpal tunnel syndrome. MRI’s, x-rays, and nerve testing were done on patients with carpal tunnel syndrome, and another group with referred pain from the neck and into the wrist and hand. Another group of subjects, with no symptoms at all, served as the control. The x-rays showed that degeneration of the disks in the neck were present in both patient groups. The MRI took things a step further, to see if the tiny holes between the neck bones showed narrowing and a pincer effect on the nerves.

This study showed that in carpal tunnel syndrome there is often degenerative changes in the neck and supported the “double-crush” nerve hypothesis. Seeing a doctor of chiropractic to make sure that your wrist and neck is properly examined is key to proper diagnosis. Without proper assessments, treatments are often unsuccessful, especially surgery. Before embarking on the more invasive option of surgery, consider conservative chiropractic care. If the problem in your wrist is more a problem in your neck, specific wrist treatments will be ineffective.

If you are interested in more information on how I treat CTS log on to www.ReliefFromCarpalTunnel.com and order a free report.

Carpal Tunnel and Its Diagnosis

Pain in the wrist and hand can be a difficult thing to diagnose properly. The first problem is deciding what type of doctor to see. A chiropractor,  internist, orthopedist, rheumatologist, or neurologist, will all agree to schedule you for an appointment, but who is best?

At your visit it’s important to have a thorough examination and to ask a lot of questions. I’d be skeptical if the doctor only examines the wrist and hand, and leaves out the elbow, shoulder and neck. The reason this is the case is that problems of the neck and other joints distal to the pain, can refer pain into the wrist and hand. Not all wrist pains are a problem with constriction at the carpal tunnel. Pain into the hand can come from compression of nerves in the neck. Your carpal tunnel pain needs to separated from a problem in the neck, such as a radiculopathy or thoracic outlet syndrome.

Your doctor should ask are how long the problem has lasted, and if there has been any trauma. Trauma to the neck is especially important, and could be a sign that your wrist problem is really a neck injury.

Some patients simply need to have their computer monitor adjusted, or are given stretching exercises to do between long periods at the computer keyboard. The stretching may be for the wrist, but should also address the entire arm and neck to be comprehensive. How we sit and whether there is forward head posture are also important considerations. The forward head posture can stretch your spinal cord and nerve roots making the nerves more susceptible to pressure when they eventually pass through the carpal tunnel.

In others, the problem of joint alignment needs to be properly addressed. Through specific chiropractic adjustments, the motion of the joints and their alignment can be restored. The misalignments may occur at the wrist or even the neck.

I am Dr. Paul Kramer D.C. and I treat many patients with carpal tunnel symptoms. Sometimes the problem is local to the wrist but most patients will require a more comprehensive approach. If you’d like care that emphasizes proper posture and alignment and avoids the problems of long- term medication use, then log on to www.relieffromcarpaltunnel.com

YOU MAYBE A CANDIDATE FOR DRUG FREE RELIEF!

www.relieffromcarpaltunnel.com

Carpal Tunnel Syndrome (CTS): Management Strategies

Many patients ask whether I treat conditions like carpal tunnel syndrome.   Usually they are surprised to learn that chiropractic approaches are very effective for this condition.

Interestingly, it is the rule rather than the exception that carpal tunnel syndrome is accompanied with other conditions also caused by repetitive types of activities like work or hobbies.  Therefore, a very important treatment strategy is educating the patient about the causes of CTS.  Overuse and fatigue typically precedes the onset of carpal tunnel syndrome.

Other types of conditions affecting the upper extremity such as tennis elbow, shoulder bursitis, and neck pain are often present with the CTS.  Once all the conditions are identified, the next important aspect in the treatment process is gaining an understanding of the patient’s work or hobbies. A successful outcome is dependent on identifying faulty workstations and modifying the work environment so that repetitive forces in awkward positions can be corrected.  This is important because the most effective treatment approach can be made totally ineffective by a faulty workstation.

To find out more about how I treat carpal tunnel syndrome, log on to www.relieffromcarpaltunnel.com