Do I Really Have Carpal Tunnel?

Pain in the wrist and hand can be a difficult thing to diagnose properly.

When you visit your doctor, 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, 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 correctly differentiated from a problem in the neck, shoulder or elbow.

It is very common to have a problem in the neck and in the carpal tunnel at the same time.  This is called “Double Crush”.

Your doctor should ask 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. 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.

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 avoids the dangers of drugs and surgery, then log on to: http://www.relieffromcarpaltunnel.com

Can Carpal Tunnel Syndrome Cause Other Injuries?

Carpal Tunnel Syndrome (CTS) is a very common complaint often associated with repetitive motion related jobs. There are 9 tendons traveling down the arm from the elbow that “merge” or come together in the relatively tight carpal tunnel, kind of like when 4 lanes of traffic suddenly narrow into 1 lane. We all know what happens when there is road construction during rush hour – traffic comes to a screeching halt and you have to sit there and wait, and wait, then move an inch or two, painfully waiting to reach the end of the construction zone. However, when its not rush hour, traffic may not slow down much at all because there simply aren’t many cars on the road. This analogy is VERY similar to CTS as the 9 tendons and median nerve are the lanes of traffic that merge together as they travel through the tight carpal tunnel in the wrist. When a worker, let’s say a typist, works long hours at the computer typing as fast as possible (like heavy traffic during rush hour), the repetitive rubbing of the tendons in the tunnel creates friction, heat, swelling, and eventually pinching of the nerve resulting in the classic numb thumb and first four fingers. They have to stop shake their hands and flick their fingers to get the them to “wake up” and then they can resume typing again, but have to stop and go and shake/flick the hands/fingers several times during the day. As a result, they either have to take a break and rest or, compensate by shifting their body into different positions in attempt to reduce the strain on the wrist tendons.

Some of the ways we shift in attempt to reduce strain includes raising the elbows away from the sides of the body, shrugging the shoulders up towards the ears, moving the head and neck into different positions like poking the chin out, slouching, plus combinations of all or some of these. Over time, these compensatory faulty postures end up straining the other surrounding joints and when this occurs, the collection of all painful areas is referred to as “cumulative trauma disorders” or, CTDs. As you can see, it’s important to treat or manage the CTS condition early on so we can avoid the progression into the other CTDs or else, treatment will also have to address many other conditions such as (partial list): tennis and/or golfer elbow (tendonitis), shoulder tendonitis, neck or cervical strain, and/or radiating neck to arm pain (cervical disc injury with radiation of pain into the arm). CTDs can also be a contributing cause to mid and low back pain.  As these conditions gradually occur, the longer it takes to stop the progression and sometimes, many of these conditions can become permanent.

There are a lot of ways we can avoid the cascade of events that lead to CTS and other CTDs, some of which include: 1. Early intervention (treatment) – chiropractic care works particularly well at this stage. 2. Taking “mini-breaks” during the work day such as a 1-minute every 30-60 minutes to stretch the neck, shoulders, forearms, hands and fingers. 3. Performing specific carpal tunnel / wrist stretches (placing the palm of the hand on a wall at shoulder level, keep the elbow straight, pointing the fingers down towards the floor). 4. Wearing a splint, especially at night (this prohibits extreme wrist bent positions and the numbness feeling that can wake us up at night). 5. Modifying a workstation, such as moving the computer monitor so the neck/head point straight ahead. Work station modifications can also reduce awkward hand/wrist positions that overload the tendons of the wrists by lowering the mouse and/or keyboard if they are too high, or padding a sharp countertop edge to prevent it from digging into the forearm and further pinching the nerve.

YOU MAY BE A CANDIDATE FOR DRUG FREE, SURGERY FREE TREATMENT OF CARPAL TUNNEL SYNDROME!  FOR MORE INFORMATION LOG ON TO: www.relieffromcarpaltunnel.com

Carpal Tunnel Syndrome: Can We Prevent It?

The cause of carpal tunnel syndrome (CTS) is commonly associated with repetitive motions or, working long hours with fast hand movements such as on an assembly line, food packing line, waitress work, or on a computer keyboard and mouse.  However, there are many other possible causes that are less commonly discussed such as pregnancy (caused by generalized water retention), birth control pills (same reason), obesity (same reason), rheumatoid arthritis, hormonal disorders such as diabetes, thyroid disease, and menopause and others.  Of course, if one combines a fast repetitive job with a hormonal disorder, the chances are increased even more for developing CTS. Essentially, any condition that results in an increase in swelling within the carpal tunnel (wrist), will potentially cause CTS so injuries like sprains/strains, fractures, sports injuries, tendonitis and so forth are all potential causes of CTS.  Common symptoms of CTS include: numbness in the 2nd to 4th fingers/hand, pain in the same location, waking up at night needing to shake or “flick” the fingers, driving related numbness, weakness in the grip, difficulty buttoning a shirt, and performing fast repetitive tasks (sewing, crocheting, knitting, cooking) or awkward wrist position tasks (auto mechanic, waitress, musicians, electricians, plumbers, carpenters).

Knowing the cause is important when considering CTS prevention. It is also important to realize the pressure within the carpal tunnel doubles in people without CTS and increases six times in people with CTS when we flex or extend our wrist up or down so sleeping with the wrist straight REALLY HELPS!  This is why patients wear a wrist “cock-up splint” so they don’t accidentally bend their wrist when sleeping.  Night splints like this are also very effective so the swollen tendons and/or other structures in the carpal tunnel can properly “rest.” If a person has a history of CTS that comes and goes, depending on how active they are, wearing a night splint as a prevention approach is appropriate. The use of a wrist splint during the day is often NOT a good idea if it impedes one’s ability to do their normal or needed tasks.  This is because we will irritate the forearm where the splint hits when we flex / extend the wrist and localized bruising can result (sometimes increasing the symptoms of CTS).  Using a splint on long drives can also be helpful as driving frequently irritates CTS.

Here is a list of precautions that may help in reducing the onset, or if present, the frequency/intensity of CTS symptoms:

1. Reduce your force and relax your grip
2. Take frequent breaks
3. Watch your form
4. Improve your posture
5. Keep your hands warm

Though these strategies can help, make sure you properly manage any existing “other problems” listed in the middle of the 1st paragraph.  Also, as discussed in prior Health Updates, chiropractic management offers a great non-surgical solution to the management of CTS and should FIRST be utilized before considering surgery!

YOU MAY BE A CANDIDATE FOR NON-DRUG NON-SURGICAL TREATMENT OF FOR CARPAL TUNNEL SYNDROME!  FOR MORE INFORMATION LOG ON TO; WWW.RELIEFFROMCARPALTUNNEL.COM

Carpal Tunnel Syndrome and Risky Jobs

Carpal Tunnel Syndrome or CTS, is one of many “repetitive strain injuries” or RSI’s and it’s one of the most common work place injuries, second only to low back pain!  The term “Carpal Tunnel Syndrome” was first used in 1939 and since the 1950’s, this disabling overuse injury to the hand has been one of the most frequent work injuries reported. So, what jobs carry the greatest risk for developing CTS?

Basically, any job that requires fast, repetitive movements of the hands with little rest can be considered a potential “risky job.”  A partial list of the causes of RSI’s including CTS are: stress, tension/tightness of the arm muscles, inflammation of the wrist tendons, repetitive movements like keyboard/mouse work, poorly designed workstations, poor posture including awkward wrist/hand positions required on the job, heavy lift/carry workloads, vitamin deficiencies, and neck / spine complaints. Couple these jobs with age > 50, and being female – especially if she takes oral contraceptives (as they retain fluids), during pregnancy or menopause.

Here’s a list of jobs we can consider “risky”:

• Typists: When typing speeds reach 60 words / minute, for 8 hrs a day, there can be up to 25 tons of pressure each day exerted in the wrist. Frequent breaks are NEEDED!

• Computer users: The proper position is feet flat on the floor (adjustable chair necessary), arms at the side with elbows bent slightly MORE THAN 90 degrees; sitting up “tall” in the chair (prop a pillow, water bottle, or rolled up towel behind your back if necessary), tuck in the chin (avoid chin poking), and MOST IMPORTANT – TAKE BREAKS AS NEEDED.

• Musicians: If you think about it, what task requires faster, repetitive movements of the fingers in awkward positions?  For example, playing a flute. Or, how about piano, trumpet, saxophone, guitar, violin, drums… wait a minute!  Just about every instrument requires awkward hand positions and fast repetitive movements!  It’s no wonder a large percentage of musicians develop CTS / RSIs! Again, the secret is taking meaningful breaks and stretching and when it’s uncontrolled, come see us (but DON’T wait too long)!

• Line workers: There are many types of jobs where standing on a line while working in fast/repetitive environments such as assembling an engine, packing cookies, pushing wires into a harness, inserting screws, packing meat or fish, using vibrating tools, carpentry tasks such as screw driver use, hammering, sawing, lifting/carrying materials……..you get the picture!  These jobs are notorious for CTS!

• Other RSI’s: include tennis elbow, golfer’s/bowler’s elbow, cubital tunnel syndrome (numbness in the pinky), de Quervain’s disease (thumb tendonitis), and sports injuries (sprains/strains). Postal workers, cake decorators, dentists and hygienists, as well as waiters are all at risk for developing CTS.

The bottom line is: 1. Take multiple breaks. 2. Work at your own pace. 3. Wear a wrist brace at night. (If recommended) 4. See a chiropractor to loosen up those tight hand, forearm, shoulder and neck joints and muscles to relieve nerve pressure. DON’T jump right to surgery – it’s the “last resort.”

YOU MAY BE A CANDIDATE FOR NON-SURGICAL TREATMENT OF CARPAL TUNNEL SYNDROME!  FOR MORE INFORMATION LOG ON TO: www.relieffromcarpaltunnel.com

Carpal Tunnel Syndrome: Why Braces?

For those of you who have had Carpal Tunnel Syndrome, you probably know all about braces. These are devices worn on the wrist that stop you from bending the wrist up or down.  They may be worn anytime of the day if they don’t interfere too much with one’s current activity but are especially worn at night. You might think it would be more important to wear these during day when you are active and moving your fingers and hands a lot- as you go about your normal work or play activities – not at night when you’re basically just laying there doing nothing but sleeping, right?  Wrong! It’s more important to wear these at night. This is because you cannot control your hand position at night as you tend to curl up in a ball when you sleep and the wrist gets cocked up or down. So, why is this so bad?  Let’s look at the chart below on the left.

In the chart (above left), you are looking at a cross section of the wrist through the carpal tunnel.  This illustrates the many structures that are inside the tunnel making it tight. Notice the small white circles in the middle of the tunnel. Those are the tendons that pass through the tunnel – there are 9 of those and they attach the muscles in our forearms (on the palm side) to our fingers, so we can shake someone’s hand or carry a suitcase (grip). Just to the left of center, on top of all the tendons, sits the median nerve, which is just below the “roof” of the tunnel (the transverse carpal ligament). Now, normally, the pressure inside the carpal tunnel will approximately double when we bend our wrist, putting more pressure on the nerve and pushing it into the roof (ligament), which creates the numbness and/or weakness in our grip. But in the CTS sufferer, there is already more pressure in the tunnel due to the swollen tendons so when the wrist is flexed or extended, the pressure goes up much more the twice – more like 6 times more pressure – hence, more symptoms. So, if we’re sleeping with our wrist bent either way, the pressure pushing the nerve against the roof is a lot more than normal – 6x more!  This is the reason for the “night splint.”  It is VERY effective in keeping the wrist straight, which is needed to allow the nerve to NOT be pinched, so it can heal.

YOU MAY BE A CANDIDATE FOR NON-SURGICAL CARE FOR CARPAL TUNNEL SYNDROME!  FOR MORE INFORMATION LOG ON TO: www.relieffromcarpaltunnel.com

What Is Carpal Tunnel Syndrome?

So what IS CTS?  According to the National Institute of Neurological Disorders and Stroke (National Institutes of Health), CTS occurs as a result of the median nerve, which is located in the middle of the forearm and hand on the palm side, getting pinched or squeezed at the wrist.  This results in numbness, or tingling and later, weakness in the part of the hand that is innervated by the median nerve (palm and index, 3rd and half of the 4th fingers).  The reason this occurs so frequently is primarily due to the way the wrist is designed.  There are 8 little wrist bones that make up the “tunnel” (“U” shaped-see pictures)

There are 9 tendons that travel through the tunnel and the median nerve sits on top of the 9 tendons, just under the “roof” of the tunnel (a ligament). When the hands and fingers have to move rapidly such as when typing, playing piano, working on a fast paced, repetitive motion job (eg., packing cookies, meat packaging, etc.), the tendons rub together and create friction.  As a result, the tendons swell and the median nerve gets squeezed or pinched between the swollen tendons and the roof (ligament). This process results in the symptoms: numbness, tingling, burning, itching, “half-asleep,” driving numbness, difficulty picking up things with the finger tips, buttoning a shirt, grip/pinch weakness (opening a jar weakness), difficulty in differentiating between hot and cold, and sleep interruptions from the numb/tingling sensations.  If not properly treated, the muscles at the base of the thumb can shrink (“atrophy”).

Chiropractors are appropriately trained to diagnose and treat CTS – most importantly, WITHOUT SURGERY!  The following represents a logical, effective chiropractic treatment approach for CTS: 1) Joint manipulation: this includes the hand, wrist, forearm, and in some cases, the elbow, shoulder, and neck; 2) Exercises: wall/wrist stretches, isometric and isotonic resistance; 3) Cock-up wrist splint use, especially at night; 4) Ergonomic modifications (workstation issues); 5) Physical therapy modalities such as low level laser therapy.

We realize that 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 RELIEF FROM CARPAL TUNNEL SYNDROME! OR MORE INFORMATION LOG ON TO: www.relieffromcarpaltunnel.com

Vitamin Therapy For My Carpal Tunnel Syndrome?

As with most problems of the body, there are a multitude of causes and cures and rarely is there a magic bullet for anything, including carpal tunnel syndrome. At our clinic, we look at how the wrist and neck are aligned to see if there is an irritation or compression on the nerves that pass through the carpal tunnel. We use a detailed examination of both the wrist and neck to see if your carpal tunnel symptoms may actually be referred from your neck.

Most patients will benefit from other aspects of our comprehensive approach, such as specific stretches or exercises and appreciating how our lifestyle choices can also influence symptoms.

While excessive weight is a risk factor for carpal tunnel syndrome (obese and overweight patients have a greater risk for developing carpal tunnel syndrome), there are also other dietary approaches that have been tried to cure or alleviate symptoms. One of these is vitamin therapy, specifically vitamin B6. This is an important vitamin for many complex bodily functions, including maintaining a strong immune system. It also supports glucose or blood sugar functions.

Recent research (Ryan-Harshman M, Aldoori W. Carpal tunnel syndrome and vitamin B6. Canadian Family Physician 2007;53(7):1161-2.), has shown that although the research is weak on the subject, there appears to be modest evidence that supplementing their diet with vitamin B6 can help some patients with carpal tunnel syndrome. This effect has to be balanced against any known risks, which appear to be very rare and not severe. The recommended daily dose is about 100-200 mg and this can be taken for a few months with a gradual reduction in the dose after this time.  Other authorities believe it’s better to take the B vitamins in a complex form rather than one vitamin in isolation. There may be some biochemical synergy to taking the various B vitamin forms together, which is how they are often sold in stores. You can also get B6 from natural food sources such as potatoes, garbanzo beans, and fortified cereals. Older adults and those who consume excessive alcohol can be at risk for developing a vitamin B6 deficiency.

But proper treatment can only begin after a thorough diagnosis to determine the cause of your symptoms.

YOU MAYBE A CANDIDATE FOR DRUG FREE RELIEF! FOR MORE INFORMATION LOG ON TO: http://www.relieffromcarpaltunnel.com

What Isn’t Carpal Tunnel Syndrome?

That’s a strange question….well, maybe not as crazy as it sounds! Knowing what isn’t carpal tunnel syndrome, or CTS, may help you avoid an unnecessary surgery for a condition that looks very similar to CTS.  Because CTS is such a common problem, it’s not uncommon for other conditions to be mistakenly called “CTS.” Because of that, subsequent surgical treatment will fail.  So, what are similar conditions you should know about?  You’ll be surprised at the possibilities: Pronator tunnel syndrome, cubital tunnel syndrome, radial tunnel syndrome, thoracic outlet syndrome, cervical radiculopathy, peripheral neuropathy, De Quervain’s Disease, fracture/trauma, degenerative joint disease (osteoarthritis), ganglion cysts, rheumatoid arthritis (RA), serum lupus erythymatosus (SLE), scleroderma, syringomyelia, multiple sclerosis, pregnancy, obesity, hypothyroid, gout, diabetes mellitus, Paget’s Disease, acromegaly, mucopolysaccharidoses, eosinophilic fasciitis, hyperlipidemia…

Obviously, you get the picture. There are MANY conditions that can either contribute and/or “cause” CTS. So, let’s discuss how we can determine what the condition is that may be causing CTS. CTS is “likely” if none of the above causes or contributes to these symptoms of CTS:

1. Numbness/tingling in the distribution of the median nerve in the hand only (not forearm) affecting the 2nd and 3rd (sometimes part of the 4th) fingers.
2. The need to shake and “flick” your fingers repeatedly during certain activities such as writing, sleeping, typing, driving, reading/holding a book / newspaper.
3. Waking up at night due to numbness.
4. Difficulty buttoning a shirt, picking up fine things, unscrewing a jar, riding a bike and more.

It may be necessary and appropriate to have some blood tests performed to help “rule out” (that means, “…get rid of..”) some of the above long list of conditions.  Some of these blood tests include (but are not limited to): a sedimentation rate (ESR), rheumatoid factor (RA), ANA antibody test (for SLE), uric acid (for gout), glucose (for diabetes mellitus), thyroid profile (for hypothyroid), lipid profile and even a Lyme’s disease test to rule out the possibilities of that!  If any of these blood test return “positive,” get those conditions treated FIRST before consenting to CTS surgery so you can avoid having a poor / unsatisfying result.  Remember, you can always have surgery later, but you can’t “undo” the surgery after the fact (if it doesn’t help).

Therefore, why not consider a non-surgical treatment FIRST and if that fails, AND, blood tests prove none of the above conditions are present, THEN you can feel more comfortable that no underlying condition is present that is causing or adding to CTS.  Some of the common non-surgical treatments you can expect from our chiropractic approach for CTS include: wrist manipulation / mobilization, active release technique (ART) applied to the flexor forearm muscles, night wrist splint use, low level laser therapy, activity modifications, ergonomic or work station modifications.  Once you’re sure no other underlying metabolic cause or contributor is present, call us and we will help you with our non-surgical, no negative side-effect treatment approach!

We realize 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 A FREE NO-OBLIGATION CONSULTATION CALL 262-251-8306

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