Carpal Tunnel Syndrome (CTS) – What, Why, How?

WHAT? Carpal Tunnel Syndrome (CTS) is the most common of the peripheral nerve conditions and occurs when the median nerve is compressed or pinched at the wrist. The resulting symptoms include numbness/pain in the wrist, fingers (index, third, and forth), multiple sleep interruptions due to hand/finger numbness requiring frequent shaking and flicking, difficulty in gripping or pinching such as buttoning a shirt, threading a needle, lifting a coffee cup, frequent dropping of objects, and the inability to perform work duties. Pain can even shoot up the arm towards the shoulder and into the neck. Because there are nine tendons that also pass through the carpal tunnel in addition to the median nerve, even a little swelling can cause symptoms.

WHY? There are many possible causes but in general, whether its swelling, a spur, or a metabolic condition, the common denominator is pressure on the median nerve in the confined space within the carpal tunnel. A common cause of swelling can occur when an individual performs repetitive motion work such as line assembly, meat packing, carpentry, and so on. Over time, the tendons inside the tunnel inflame or swell and the median nerve is pressed into the ligament that crosses over the roof of the tunnel on the palm side of the wrist. Once the contents inside the tunnel swell, all positions of the wrist other than neutral (holding the wrist in line with the forearm) further increase the pressure inside the tunnel. That is why sleeping with the wrist bent in any direction often wakes up CTS patients. CTS can also be associated with health conditions including (but not limited to): Lyme disease, inflammatory arthritis, and hormone-related conditions including pregnancy, taking birth control pills (BCPs), hypothyroidism, diabetes, and menopause. Lifestyle issues that affect CTS may include high caffeine intake, smoking, alcohol consumption, as well as obesity.

HOW? So, the key question is how are we going to help those with CTS? First, we must identify all the possible reasons why CTS developed in the first place and manage those issues. Therefore, an ergonomic (workplace) assessment or discussion or possibly observing the patient at work can be very helpful. Sometimes, a few simple changes to a workstation such as moving the monitor of a computer in line with the keyboard/mouse or adjusting the height of the monitor can really help. Changing a tool handle type (pistol vs. straight grip), propping up a part that is frequently worked on, moving the product closer to where it is being assembled, eliminating overhead reach requirements, standing on a raised platform, and so on, may be most important for achieving long-term, lasting results. Identifying and treating any condition that may be participating in the cause like thyroid disease, diabetes, medication (like BCPs), and weight management, is very important. Wearing a night splint is also very productive. Treatments unique to chiropractic include manipulation of the neck, shoulder, elbow, forearm, wrist, and fingers; soft-tissue therapy, including massage; mobilizing the forearm muscles and tendons; teaching carpal stretch and other upper extremity exercises; and nutritional counseling. Nutritional strategies can include eliminating any suspected food allergy-related products including dairy, glutens (wheat, oats, barley, rye), soy, corn, transfats, preservatives, and some chemical additives. Increasing B-vitamins (especially B6), by increasing dark leafy vegetables intake and increasing antioxidants including fruits and veggies may also be recommended. An anti-inflammatory vitamin program of fish oil, vitamin D-3, magnesium, CoQ10, and a multiple vit./mineral may facilitate as well. Once CTS is controlled, preventing a recurrence is important by promoting good posture, exercise, and sticking with the lifestyle adjustments described above.