Posted by admin | Posted in Model Railway | Posted on 01-06-2009
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Carpal Tunnel: The Chiropractic Approach
Carpal Tunnel Syndrome is a very common condition nowadays, especially in people over 50 years of age. Statistics indicate that women are diagnosed more often than men with a ratio of 3:1 in between the ages of 45-60 years of age. Only 10% of reported cases of CTS are younger than 30 years of age. It occurs in around three per cent of men and 11 per cent of women at some point in their lives. It is most prevalent in manual workers, including computer programmers, assembly line workers, gardeners, golfers and the list could go on. Carpal Tunnel Syndrome first became prevalent following World War Two, while the first use of the term was noted 1939. However there were documented reports as early as the 1800s. It is one of the most frequent work injuries reported by the health professions today.
What Is The Carpal Tunnel and What Causes Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome, or CTS, is a collection of various symptoms and clinical presentations, which are caused by compression of the median nerve as it passes through the carpal tunnel. The carpal tunnel is a narrow tunnel, in the palm side of the wrist. It is surrounded on three sides by the bones of the hand (carpal bones) creating an arch. Running through the tunnel are nine flexor tendons, together with the median nerve, which controls muscles around the thumb. The nerve and the tendons provide function, feeling, and movement to some of the fingers. The finger and wrist flexor muscles including their tendons originate in the forearm at the medial epicondyle of the elbow joint and attach to the bones of the fingers and thumb. The floor of the tunnel are the wrist bones; the sides are the tendons of the fingers, and the top is the transverse carpal ligament. The carpal tunnel is not very big and does not have much room. If there is any swelling, this will result in pressure on the nerve, and the symptoms of carpal tunnel syndrome may appear. The median nerve can be compressed by a decrease in the size of the tunnel, an increase in the size of the structures in the tunnel, such as the swelling of tissues around the flexor tendons, or both. Flexing the wrist alone, up to or greater than 90 degrees will decrease the size of the canal.
Symptoms of Carpal Tunnel Syndrome
Carpal tunnel syndrome symptoms range from mild discomfort or sensations to extreme pain, weakness and parasthesia (abnormal sensations such as pins, needles and burning).. These symptoms progressively worsen over time and patients that have been diagnosed with CTS often experience burning sensations, numbness and tingling in the thumb and fingers, particularly the index and middle fingers, which are affected by the median nerve. Individuals also experience pain in the wrists or hands and some people also lose gripping strength. Pain may also develop in the arms and shoulders and swelling of the hand. The pain may be worse at night do to the different sleeping positions.
Numbness and parasthesia in the median nerve dermatome and myotomes (areas of skin and muscle the nerve supplies) are the neurological symptoms of Carpal Tunnel Syndrome. Weakness and atrophy of the wrist and hand muscles may occur if the condition remains untreated.
What Can Cause Carpal Tunnel Syndrome?
Any condition that causes increased pressure on the median nerve at the Carpal Tunnel can be included in the differential diagnosis of CTS. A large percentage of CTS sufferers, have been found to be of unknown cause for their symptoms. Some people may be genetically predisposed to this condition. Diabetes, arthritis, hypothyroidism and direct injury are other common conditions that can lead to CTS.
"Double Crush" Syndrome
Double Crush was first described in 1973. It has been documented as involvement of multiple injury sites in repetitive strain injuries. It was found that there were associated cervical nerves involved in the pathology as well. They proposed that if a nerve is impaired at one location it makes that patient more susceptible to other entrapments along the same nerve distribution. They felt that either nerve compression alone or by itself would not be enough to cause clinical dysfunction. The two or more sites of nerve compression may slow axonal transport, thus creating conduction abnormalities. They concluded it is of vital importance to identify each area of nerve compression or entrapment and treat each one individually.
In CTS, many times the nerves to the hand are damaged due to injuries of the wrist along with concurrent injuries ranging from the forearm to the upper neck ("Double Crush"). They may present with neck pain. An example of this is a cervical (neck) nerve impingement causing pain, and other symptoms like numbness, tingling, and weakness in the arms (neck site) and carpal tunnel syndrome (wrist site). Determining the damage at each site may be difficult to assess, and make a definitive diagnosis unclear. Treatment of the problem at one site alone is most likely to result in ongoing and persistent symptoms. Advance testing can be done by a neurologist to determine whether the condition is indeed "Double Crush." Nerve conduction studies and needle electromyography to determine specific sites of damage and nerve root compression.
What Can Be Done For Carpal Tunnel Syndrome or "Double Crush Syndrome?"
Stretching exercises for the fingers wrist and hand are a good preventative strategy to decrease the possibility of Carpal Tunnel Syndrome. This may help to minimise numbness and pain caused by repetitive stress to the involved areas. In more chronic cases use of night splints may be helpful. A more aggressive approach includes corticosteroid injections and ultimately surgery. Surgical procedures have been developed over the years to "release" the pressure on the nerves at the carpal tunnel by permanently severing the ligament that holds the tunnel together.
The Chiropractic Approach
CTS is commonly treated by Chiropractors. Modern techniques and procedures have shown Chiropractic may be very effective at reducing symptoms of carpal tunnel syndrome and improve overall function. The methods most chiropractors use to treat CTS include adjustments and mobilisation of the wrist, elbow, and spine. Safe, gentle and effective adjustments, in combination with the other mentioned supporting preventative measures may not only reduce pain, numbness and burning that accompany Carpal Tunnel Syndrome, may help strengthen and increase the functionality of the involved areas. This may decrease the likelihood of the problem coming back. How frequent a person needs to be adjusted would depend not only on that persons individual history and exam findings, but also the repetitive nature of the stress that contributed to the original injury.
If you think you may be a sufferer of Carpal Tunnel Syndrome, or have struggled to get relief from your current approach, consulting with your Chiropractor may be helpful. They will perform a thorough history and consultation, a complete physical exam including orthopaedic, neurological and xray exam. Further testing may also be necessary depending on the severity and nature of the problem.
Chiropractic care may provide a safe, conservative approach to managing your condition, and helping you back to optimum health.
Be sure to check out "Chiropractic Exposed!" A Free 11 Day Mini course ALL About Chiropractic!
About the Author
Stacey Burke is a Doctor of Chiropractic and co-founder of West Coast Family Chiropractic in Hillarys, Perth West Australia. Dr. Burke graduated from Logan College of Chiropractic in 1996. He also holds an International Chiropractic Sports Science Diploma (I.C.S.S.D.). He is married and has two sons and daughter. Dr. Burke is a six time Ironman Triathlon Finisher and enjoys cycling, running and ice hockey. His purpose at the Hillarys Chiropractic office is to help families , and the community restore and maintain their health through natural chiropractic methods, community outreach, and education.