Carpal
tunnel syndrome (CTS) is the most commonly diagnosed disabling
condition of the upper extremities (your arms). CTS can very
dramatically decrease your quality of life, interfering with sleep,
productivity at work, focus, and takes the enjoyment out of leisure
activities. This condition has such a chronic nature it can have a
negative impact on your mood as well. People with CTS suffer from
chronic numbness and/or tingling in the hands, loss of grip strength and
dexterity, discomfort in the forearms, difficulty finding a comfortable
sleeping position due to numbness and tingling, and they often have
head and neck complaints.
"True" carpal tunnel syndrome is defined
as compression of the median nerve in the carpal tunnel. The carpal
tunnel is your wrist. The bones of the wrist and the flexor retinaculum
create the walls of this tunnel. Within that you have 10 tendons,
synovial sheaths, and the median nerve. Chronic compression of the
median nerve is what creates carpal tunnel syndrome. Nerves are
responsible for sensations such as pain, light touch, vibration and
proprioception. They need good circulation. In this way, they are just
like blood vessels; if you compress them, blood cannot circulate. Your
limb falls asleep and turns blue. If you compress a nerve, it has a
really hard time transmitting neurological information. This can result
in pain, numbness, weakness, tingling, etc. In order to restore
neurological flow, the compression has to be removed.
Since we are
talking about carpal tunnel syndrome, it should be obvious: the
compression is happening at the wrist. Yes, this is usually a part of
the compression, but most times the compression is not solely coming
from the wrist. You can have compression from several places along the
neck and arm all creating and compounding the compression. You can also
have inflammation of the tissues that creates the actual compression
within the wrist.
More often than not, people with carpal tunnel
type symptoms are not just having compression of the median nerve. There
are 5 main nerves that stem from the brachial plexus; (1) Axillary, (2)
Musculocutaneous, (3) Median, (4) Ulnar, and (5) Radial. These nerves
start in the neck, branch through your arms and some continue to the
fingers.
The median nerve is the only nerve that passes through
the carpal tunnel, but the other four nerves can also contribute to
these types of symptoms in the shoulder and arm. Technically, this
diagnosis becomes nerve entrapment and not just carpal tunnel. With true
carpal tunnel the symptoms involve the tips of the first three and half
fingers as, well as the corresponding palmar side of the hand. You can
see the nerve sensory distributions in the picture below.
According
to American Family Physician the most common cause of carpal tunnel
syndrome is repetitive maneuvers. This includes fine motor activities
like typing, handy work (hammering, use of screw drivers), etc.
Self-care and Prevention:
If you work one of these jobs, some practices to help prevent nerve entrapment syndromes are as follows:
Self-massage.
We recommend using a medium to hard ball, tennis or lacrosse ball, to
massage the muscles of your hands, arms and shoulders.
Regular stretching of the forearms and shoulders.
Exercises
to counteract a forward rolled posture. Meaning, strengthening of your
back musculature and core. If you don't know where to start in the gym,
we highly recommend find a physical therapist or personal trainer to
help show you some great exercises.
Treatment options:
As
with any inflammatory process, we have to remove the irritant. With any
sort of repetitive injury, rest is indicated in the acute phases. This
may even require time off from work. If rest is not possible, Rocktape
or Kinesiotape can help with circulation, neuro-muscular retraining and
pain. Braces can also be helpful at work to help keep your wrist in a
better ergonomic position. Supplementation with strong anti-inflammatory
compounds like turmeric help to dampen inflammation internally and act
as an analgesic. However, neither of these options are a cure.
Over
time, with repetitive type injuries and inflammation you start to
develop fibrosis in the tissues that creates friction. To restore the
tissues back to health, they need treatment in conjunction with
self-care. In our office we often use Chiropractic manipulation, dry
needling, Graston or Gua Sha, myofascial release, cupping, and postural
retraining exercises. All of these therapies help to restore the tissues
and fascia and remove the friction through the different phases of
healing. Deep tissue massage, Rolfing and the like are other great
therapies to restore your tissues.
In cases where acute trauma was
involved, like fracture of the wrist that changed the bony structure,
or arthritic bony changes like osteophyte formation, conservative
treatment may not be able to do the trick. In these cases surgery might
be the best option. Regardless, it is still a good idea to give
conservative therapy a shot. Chances are it can greatly improve your
symptoms.
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