Carpal Tunnel is becoming more and more common of an injury that comes into my office. Carpal tunnel is defined as compression of the Median nerve as it passes through the carpal canal that causes distal hand pain, numbness, and/or weakness. Its rise may be due to the rapid increase in diabetes in the population or due to our increasing dependence on computers and technology. Activities such as typing at the computer, texting on our phones, and playing video games are all possible causes of carpal tunnel syndrome. In the past, overuse was the most common culprit. Repetitive finger or wrist flexion or extension in our everyday lives affected many of the trades, particularly mechanics, carpenters, cashiers, and secretaries. Repetitive hand movements seen in beauticians, seamstresses, and writers were all common problems as well. Constant arm and hand vibration can also lead to symptoms seen most commonly in truck drivers and persons that operate machinery and vibratory tools such as sanders and jackhammers. Another outside cause that is typically overlooked by physicians is constant pressure at the wrist in the form of watches or bracelets that are too tight or casts and bandages used to stabilize an injury. Trauma can of course cause carpal tunnel in the form of Colles fractures of the wrist, osteoarthritis, and Ganglion cysts but are not as common. Other systemic causes include diabetes, pregnancy, thyroid disease, renal disease, and multiple myeloma.
The common signs and symptoms of carpal tunnel include hand and wrist pain. Occasionally the pain can refer back to the arm and neck. Paresthesia (numbness and tingling) is common in the hand in the distribution area of the median nerve which includes the thumb, pointer and middle finger, and half of the ring finger. In true median nerve compression the outer half of the ring finger and the little finger are symptom free. A burning pain in the hands is common but is usually experienced more at night. Hand, wrist, and finger stiffness can occur especially after periods of rest. Grip weakness and clumsiness in the hands can result from chronic compression. Carpal tunnel affects females more than males (6:1) and occurs most commonly in middle aged persons in the range of 40-60 years old. It typically affects the dominant hand but can occur bilaterally.
There are many different treatments to alleviate the pressure on the median nerve and reduce the signs and symptoms of carpal tunnel syndrome. Some can be done at home and some require the assistance of a trained professional. In my office we follow a treatment protocol that involves both in office and at home therapies. First, the person needs to avoid the identified repetitive motion as much as possible. In some severe cases this can require time off from work to fully resolve issues. If these repetitive movements cannot be avoided, bracing can be used to relieve some of the stress. Cock-up splints can also be worn at night time when necessary. In the office, we begin with a combination therapy of ultrasound and electric muscle stimulation at the wrist and forearm to decrease muscle spasm and break up adhesions in the tunnel. Myofascial release and special stretches targeting the muscles of the forearm and hand are used to increase range of motion and further release adhesions and scarring. Adjustments of the bones of the wrist and distal arm are used to free fixations and correct subluxations of bones that can cause additional nerve compression. Deep tissue massage and trigger point therapy is usually required throughout the forearm. A specialized exercise and stretching program is given to be preformed at home along with the use of ice and/or heat depending on the stage of injury. In acute stages transverse ice massage is recommended in order to reduce swelling. In sub-acute phases ice and hear are alternated, and in chronic phases hot packs are recommended. Nutritionally, patients should restrict salts and foods high in sodium in order to reduce swelling and vitamins B6 and C are useful in the healing of connective tissues. If you have any questions or would like to talk to Dr Dolan in person feel free to call Dolan Family Chiropractic at 630-236-3090 or visit the website at http://Dolanchiro.com
