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Many people we meet and many patients mention they have or have had carpal tunnel syndrome. Carpal Tunnel syndrome (CTS), and many similar conditions, are becoming more and more common. CTS tends to be more frequent among people who do repetitive hand movements and gripping such as typists, factory-line workers, and meat packers, as well as people who perform jobs that involve vibrating equipment, and many others. There is also a predisposition in people with certain forms of arthritis, diabetes, and in pregnant women due in part to fluid retention. Incidence overall is estimated to be three times as high in women compared to men.
CTS is caused by compression or irritation of the median nerve at the wrist. The median nerve supplies muscles that control the thumb as well as sensation to part of the thumb, the pointer and middle finger, and part of the ring finger. The median nerve passes through the carpal tunnel, which is bordered by the bones of the wrist on three sides, and a tendon sheath (called the flexor retinaculum) on the fourth. It also shares the tunnel with the tendons that go to the fingers. The flexor retinaculum is there to keep the tendons contained within the carpal tunnel and helps with wrist stability.
When the median nerve gets compressed, people usually experience pain in the wrist, numbness and/or tingling in the fingers supplied by it, and eventually changes in pinching and grip strength of the hand. Sometimes patients will even experience symptoms up the forearm. Symptoms are usually first noticed at night due to the position of the wrist during sleep. They are often also dismissed because the person assumes it is just from sleeping on their arm. As it progresses, symptoms will become more apparent during the day.
It is important to differentiate whether or not someone has CTS or another problem with numbness or tingling in the hands or arm before attempting to do anything about it. Often people and their doctors assume that because the patient has numbness in some part of their hand or forearm and they type on the computer a lot, that this must be their problem.
However, there are many other disorders and conditions that can be similar. The nerves that supply the hands leave the spine in the lower neck. When one of the nerves gets irritated or pinched it can cause numbness, tingling, or pain down the arm and into the forearm and hand. Additionally, the nerve may be irritated or compressed in some other part of the arm. Certain types of muscle problems also can contribute to pain and symptoms in the forearm and hand.
There are many therapies used to try to treat carpal tunnel syndrome. Often the first step is to use a splint that holds the wrist straight at night, and sometimes while working. There are ergonomic changes that can be made to the keyboard and workspace that can help as well. There seems to be a correlation between inadequate levels of certain B-vitamins, especially B6, and CTS. It is important for patients to take a B-vitamin supplement when undergoing treatment for CTS.
Surgery is a common treatment with mixed results. Research on the subject shows wide differences in success rates of surgery, anywhere from 40% to 98%. Sometimes these outcomes are skewed because workers may not return to the same job or type of activity post-surgery. Steroid injections provide relief; however, it is often temporary and symptoms usually return if no other intervention is used. Chiropractic and other forms of manipulation of the wrist and hand, stretching, traction, massage and acupuncture all have shown success in helping CTS, but more research is needed.
Lifestyle changes are important, including doing certain stretches for the muscles of the hands and forearm, and taking frequent breaks from the offending activity. Some studies suggest that taking “micro breaks” (30 seconds or so every 3-5 minutes) is more effective than taking longer breaks less often.
It is always important to consult a physician who specializes in muscle and joint injury before embarking on any sort of treatment routine. The proper diagnosis is important to choosing the right treatment and, in turn, it’s effectiveness. It is also reasonable to try conservative, non-invasive therapies such as supplementation, manipulation and exercises, or acupuncture first, opting for surgery when conservative interventions fail. It is also important to take these concerns to a healthcare professional as soon as they begin, because they sooner your problem is identified, the more quickly it can be relieved.
Chad Lambert, DC and Christina Lambert, L. Ac practice chiropractic and acupuncture at Alliance Health Center on Honeycutt Rd. here in Maricopa. They can be reached at (520) 568-4494.
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