Saturday, July 20, 2013

Chiropractic Treatment of Carpal Tunnel

Carpal Tunnel Syndrome is caused by the compression of the median nerve as it passes through the carpal canal in the wrist. It affects women more than men and is most commonly seen between the ages of 35 and 60. Typically it affects one hand, more commonly being the dominant hand, but in severe cases it can affect both hands at the same time. Carpal tunnel syndrome presents as pain, numbness, tingling, and weakness in the palm through the thumb, pointer finger, middle finger, and part of the ring finger. Occasionally the pain can radiate upward into the forearm, elbow, arm, and even to the shoulder on the affected side. The symptoms can come and go with varying degrees of activity and is often experienced more at night during and after sleep. In left untreated, advanced muscle atrophy, grip weakness, and clumsiness can occur in the hand. Patients may note difficulty abducting and opposing the affected thumb and even a decrease in the muscle size and tone of the thenar muscles of the affected thumb in advanced cases. Certain orthopedic test findings may be present including positive Phalen's Test, Reverse Phalen's Test, and Tinel's but a more evident test to determine if the median nerve is being compressed is by simply applying direct pressure over the carpal tunnel with your thumb and seeing if it reproduces the symptoms. Special tests can be useful in diagnosing carpal tunnel including nerve conduction velocity tests (NCV) and electromyographic studies as well as MRI and diagnostic ultrasounds.

Causes of carpal tunnel are numerous but the most commonly found cause is overuse. Repetitive motions throughout the day are found in many different occupations. Repetitive wrist or finger flexion and extension and ulnar deviation are the most common movements found to cause carpal tunnel. Repetitive fine movements of the fingers as seen with seamstresses, writers, and typists can cause carpal tunnel symptoms to occur. Constant gripping, twisting of the wrists, and back and forth movements are other triggers that are commonly seen in tradesmen, cashiers, and mechanics. Constant pressure at the wrist can also be a cause. This is usually seen with tight fitting watches, bracelets, casts, and bandages. Trauma and fractures can also be a cause of carpal tunnel symptoms as well as certain ailments that cause swelling at the wrist including rheumatoid arthritis, osteoarthritis, neuromas, ganglion cysts, and subluxations. Carpal Tunnel can also accompany pregnancy, diabetes, kidney disease, and hypothyroidism.

There are many different options for treatment of your carpal tunnel but this article will focus on non-invasive and alternative treatments that can be preformed in a chiropractic office. Initially, all patients must identify the activities that are causing the symptoms and modify or remove them. If the motion is necessary or work related, a carpal tunnel brace is recommended as well as taking frequent small breaks from the activity when possible to rest. When the pain is severe, ice is recommended over the wrist to reduce swelling. Massage and manipulation by a chiropractor is very helpful to restore proper positioning of the carpal bones and to reduce fixation in the wrist and carpal bones especially of the lunate bone. Chiropractic manipulation of the wrist and the neck, where the median nerve originates, has been proven to reduce symptoms and restore proper functioning. Massage work on the muscles of the forearm is helpful, especially myofascial release and Active Release Technique (ART). Proper stretching will help to loosen up the area which usually entails "prayer position" and "reverse prayer position" stretches. Some chiropractors may use therapeutic ultrasound and electric muscle stimulation at the wrist to break up adhesions, reduce swelling, and decrease the pain. Cock-up splints are recommended in some cases to be worn at night and straight wrist braces can be used at work or during exercise. Vitamin B6, Vitamin C, bromalain, and bioflavenoids have been shown to help and a low salt diet should be used to reduce swelling and fluid retention. Anyone taking medications or being treated for a serious illness should consult their doctor before changing their diet or taking any nutritional supplements.

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