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
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
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
Can Neck Problems Cause Carpal Tunnel Syndrome?
Neck problems are a common cause of pain and numbness in the hands. The nerve involved in Carpal Tunnel Syndrome (CTS) is called the Median Nerve and it runs from your first three fingers, thru the carpal tunnel, up your arm, to your neck.
CTS happens when the tendons of the wrist swell and compress the median nerve as it passes thru the carpal tunnel.
However, if the nerve is pinched at the neck, you can get the same pain and numbness in the hands as when you have CTS. The symptoms are the same, but the nerve is compressed in the neck, not the wrist.
You can also have a condition called “double crush” where the nerve is compressed at both sites. Chiropractors have known for decades that the reason CTS surgery has such a high failure rate, is because undiagnosed neck problems are not addressed. A growing body of research is supporting treatment of the wrist and the neck for CTS.
An article appearing in the March 2009 issue of the Journal Of Orthopedic Sports and Physical Therapy showed that people with CTS have larger postural distortions in the neck and less range of motion than normal healthy people. Other studies have confirmed that pinched nerves in the neck are often mis-diagnosed as CTS.
If you are interested in more information on how I treat CTS log on to www.ReliefFromCarpalTunnel.com and order a free report.
J Orthop Sports Phys Ther 2009;39(9):658-664, Epub 19 March 2009.
doi:10.2519/jospt.2009.3058
Carpal Tunnel Syndrome-Who Can Fix It?
When you have painful carpal tunnel syndrome (CTS), life can be miserable. Dreams and goals are often put on hold. What’s worse, many CTS sufferers don’t know what type of doctor to go to or where to get accurate, cutting edge advise.
Chiropractors are often thought of as just “back doctors” but research shows they can be a big help with CTS. For example, one study reported significant improvements in strength, range of motion, and pain reduction after chiropractic treatment was given to 25 patients diagnosed with CTS. Even better, the majority of the patients reported continued improvements for 6 months or more.
In another study, this time comparing chiropractic care to standard medical care between 91 patients with CTS, one group received standard medical care (night wrist splint and 2400 mg/day of ibuprofen). A second group received chiropractic treatment that consisted of spinal and wrist adjustments, ultrasound, and wrist splinting at night. This study proved that chiropractic care could be included as a drug free form of therapy for patients with CTS.
Like all doctors’ offices, care may vary from office to office. But, if you are looking for a Chiropractor who offers safe and effective wrist and hand symptom care, log on to www.relieffromcarpaltunnel.com for more information.
Or call 262-251-8306 and talk to Jennifer about a free consultation with no obligation for treatment.
References
1) Davis PT, Hulbert JR, Kassak KM, Meyer JJ. Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trial. Manipulative Physiol Ther. 1998;21(5):317-326.
2. Bonebrake AR, Fernandez JE, Dahalan JB, Marley RJ. A treatment for carpal tunnel syndrome. Manipulative Physiol Ther. 1993;16(3):125-139.
Carpal Tunnel Syndrome (CTS) – “Fact Sheet”
What is it?
Carpal Tunnel Syndrome (CTS) occurs when a nerve on the palm side of the wrist is pinched. It is named after the area of the wrist where the nerve irritation occurs. The Carpal Tunnel is basically a horseshoe shape made from 8 small carpal bones and the ends of the horseshoe are connected with a ligament. This creates a tunnel where the a nerve called the median nerve and 9 tendons that control your fingers pass through.
What are the symptoms?
CTS symptoms start with pain in the wrist from the swelling of the tendons inside the Carpal Tunnel. When the nerve pinch occurs, numbness, tingling, or a half asleep sensation going into the 2nd, 3rd, and 4th fingers occurs. This is often worse at night due to the wrist being bent when asleep. This often wakes the person and shaking/flicking the hand/fingers is needed to “wake them up.” Grip weakness is also associated with CTS and the person may have difficulty holding onto objects or handling small parts.
What are the causes?
Usually, over use from repetitive work like meat packing, typing, sewing, carpentry and waiting tables. These fast/repetitive movements cause swelling of the 9 tendons of the carpal tunnel which eventually irritates the median nerve. Other causes include hormone related conditions such as hypothyroidism, dysmenorrheal, diabetes, and poor dietary habits. Basically anything that causes the wrists to swell can lead to CTS.
How is it diagnosed?
The history of the symptoms as well as physical examination of the hands, arms, shoulders and neck leads to the correct diagnosis. The exam consists of trying to reproduce the numbness in the fingers by pressing over the wrist and other areas where the nerve runs down the arm (including the neck where the nerve originates), tapping over the Carpal Tunnel with a reflex hammer, bending and holding the wrists at the extreme endpoints of motion. More sophisticated testing includes an EMG (nerve conduction test) that tests the motor and sensory changes when the nerve is pinched.
How is it treated?
Chiropractic approaches include manipulation of the wrist, hand, forearm, shoulder and neck, specifically addressing the areas where the Median nerve can get pinched stretched or irritated. Soft tissue therapy includes massage and physical therapy modalities such as low level laser. Exercise training to stretch and strengthen the wrists and forearms is very helpful. Nutritional counseling and supplementation is often necessary.
You May be a candidate for a treatment of Carpal Tunnel Syndrome without Drugs or Surgery! For More information, log on to: www.relieffromcarpaltunnel.com
Or To Schedule a FREE no obligation consultation with me, Dr. Paul Kramer, call Leah or Jennifer at 262-251-8306
Should I have Carpal Tunnel Surgery ?
Carpal Tunnel Syndrome is a painful condition that causes symptoms of pain, swelling, numbness, tingling, and loss of strength and coordination in the thumb, index, middle and sometimes one-half of the ring finger. Not all of the symptoms or fingers have to be involved at the same time, because symptoms often vary and can move around. (Symptoms occuring in the ring and little finger are not carpal tunnel syndrome and are related to a completely different problem.)
Carpal Tunnel Syndrome is caused by swelling in the tendons of the wrist. Tendons swell from over use and the swelling compresses a nerve (called the Median nerve) as it passes through a space in your wrist called the Carpal Tunnel.
Surgery is one option for treating this disabling condition; however, it remains a controversial choice and it is important to fully understand the risks and benefits involved. Too often patients are rushed into surgery before other conservative options have been tried. The reason for this misdirection is often due to the fact that a surgeon will make between $4-5,000 for each 30-minute surgical procedure.
Here are some things to consider before you go for surgery:
- 77% of all Carpal Tunnel Syndrome patients could not return to their previous professions following surgery, according to the Bureau of Labor & Statistics and the National Institute for Occupational Safety & Health (1997-2000 Statistics).
- Carpal Tunnel Surgery has about a 57% failure rate following patients from 1-day to 6-years. At least one of the following symptoms re-occurred during this time: Pain, Numbness, Tingling sensations. Source: Nancollas, et al, 1995. J. Hand Surgery.
- Up to 36% of all Carpal Tunnel Syndrome patients require unlimited ongoing medical treatment.
- It has been shown in multiple studies that carpal tunnel syndrome patients are often mis-diagnosed and are told to have the surgery, when they don’t even have it.
Surgery is by far the most invasive procedure and you need to think about it carefully because the majority of those undergoing the knife do not get long-term relief. Also, scar tissue can develop from the surgery that can make the problem even worse.
In contrast, the vast majority of patients do better with conservative treatment. It is estimated that less than 1/3 of all carpal tunnel syndrome sufferers actually require surgical intervention. Surgery is only recommended when there is persistent, debilitating pain, badly deteriorated grip, muscle wasting and all other conservative methods have been tried.
One thing you need to know is, you don’t need to be in a hurry to get surgery. As much as it is bothering you, you do have time to explore your options.
Chiropractic care and cold laser therapy have been found to be very effective in eliminating carpal tunnel syndrome without drugs or surgery. To find out more about these options log on to www.ReliefFromCarpalTunnel.com and order a copy of my free report “What many doctors don’t know about Carpal Tunnel Syndrome.”
Or, you can call my office at 262-251-8306 and talk to Jennifer or Leah about scheduling a FREE no obligation consultation. It will give both of us a chance to meet, talk about your problem and see if I can help.