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

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

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

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): 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