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.

Carpal tunnel syndrome is by far the most common and widely known of the “pinched nerve” conditions. This article addresses: What is it? Who is at risk for this condition? How is it diagnosed? What kinds of treatments work best?

Carpal tunnel syndrome refers to symptoms caused by entrapment of the median nerve in the carpal tunnel. “Carpal” itself means “wrist,” so a carpal tunnel is nothing more than a wrist tunnel. This particular tunnel can be a crowded place, as it contains not just the median nerve, but nine tendons as well. The “syndrome” consists of some combination of pain, numbness and weakness.

Pain, numbness, or both, are the usual earliest symptoms of carpal tunnel syndrome. Pain can affect the fingers, hand, wrist and forearm, but not usually the upper arm or shoulder. Numbness affects the palm side of the thumb and fingers, but usually spares the little finger because it’s connected to a different nerve.

When weakness is present, it usually indicates that the condition is already severe, and when muscles atrophy (wither) it means the condition is even worse. The affected muscles are those downstream from where the nerve is pinched, and can include those controlling any of three motions of the thumb. In addition, bending of the first knuckles of the index and middle fingers can be affected, as can straightening of the second knuckles of the same fingers. When muscle atrophy is present, it is most evident in the muscular ball at the base of the thumb.

Carpal tunnel syndrome occurs more frequently in women than in men. People who work with their hands a lot – for example to sew, operate hand-tools or perform assembly-line work – are at increased risk for developing this condition. Various medical conditions can also increase the risk of carpal tunnel syndrome, including injuries, arthritis, diabetes, low levels of thyroid hormone and pregnancy. In the case of pregnancy, carpal tunnel syndrome often appears in the third trimester and resolves after the woman delivers.

Optimum diagnosis of this condition combines the time-honored methods of a doctor’s history-taking and physical examination with tests of nerve function called nerve conduction studies. Nerve conduction studies are exquisitely sensitive in detecting impairment of the median nerve at the wrist, particularly when the median nerve is compared with a nearby healthy nerve in the same patient.

In nerve conduction studies, the nerve on one side of the carpal tunnel is activated by a small shock to the skin. An oscilloscope measures how long it takes for the resulting nerve-impulse to arrive on the other side of the carpal tunnel. When the median nerve is pinched, the nerve-impulse is delayed or blocked. Nerve conduction studies are so sensitive that sometimes they show problems that aren’t even causing symptoms. That’s why nerve conduction studies don’t stand alone in diagnosing carpal tunnel syndrome. The examining physician needs to decide if the results make sense for the particular patient in question.

Nerve conduction studies not only show whether or not the median nerve is impaired at the wrist, but also provide precise data concerning how bad the impairment is. In addition, these studies survey the function of other nerves in the arm and hand. Occasionally, a nerve in an adjacent tunnel (the ulnar nerve in Guyon’s canal) can also be pinched. In other cases, nerve conduction studies show that the problem is not one of single nerve-pinches, but rather a more diffuse pattern of nerve-impairment called polyneuropathy. Of course, sometimes the studies are completely normal and suggest that the symptoms are due to something else.

To treat carpal tunnel syndrome, starting with “conservative” treatment makes sense in most cases, especially when the symptoms are still in the mild-to-moderate range. Conservative treatment usually includes a wrist-splint that holds the wrist in a neutral position. In a study published in 2005 researchers at the University of Michigan investigated the effectiveness of wrist-splinting for carpal tunnel syndrome in workers at a Midwestern auto plant. In a randomized, controlled trial -  the gold standard method for judging treatments – about half the workers received customized wrist-splints that they wore at night for six weeks. The remaining workers received education about safe workplace procedures, but no splints. After treatment the workers with splints had less pain than those without, and the difference in outcome was still evident after one year.

Conservative treatment might additionally include use of anti-inflammatory medications like aspirin or naproxen, or even steroid drugs. A more intrusive, though still non-surgical, treatment consists of injecting steroid medication into the carpal tunnel itself. This might benefit selected patients, but in a 2005 randomized, controlled study of patients with mild-to-moderate symptoms, researchers at Mersin University in Turkey showed that patients receiving splints did better than those who received steroid injections.

Surgeons can relieve pressure on a pinched median nerve by cutting a constricting, overlying band of tissue. A 2002 study at Vrije University in Amsterdam compared surgical treatment to six weeks of wrist-splinting. After 18 months 90% of the operated patients had a successful outcome compared with 75% in the splinted group.

In some cases it can be reasonable to try conservative treatments without first confirming the diagnosis with nerve conduction studies. However, in the author’s opinion, this risk-free form of testing should be performed prior to any carpal tunnel surgery. (Full disclosure: The author performs nerve conduction studies!)

(C) 2005 by Gary Cordingley

Carpal tunnel syndrome (CTS) is a devastating injury that affects more than 8 million people in the United States and continues to increase each and every year.

Carpal tunnel syndrome is one of many repetitive strain injuries (RSI’s) that are everywhere; homes, offices, assembly lines, grocery stores, book clubs, construction sites, dental offices, everywhere! Because carpal tunnel syndrome is so commonplace, and its effects so devastating, it is important to be knowledgeable of how it occurs, what its symptoms are, the testing methods used and what treatment options are available, as the prevention of any injury, especially carpal tunnel, begins with education.

Carpal tunnel syndrome is a disorder affecting the median nerve, which supplies function to the thumb, index, middle and one half of the ring finger. Usually the symptoms are most prevalent in the thumb, index and middle fingers (Sometimes one-half of the ring finger) and include numbness, tingling, paresthesia (pins and needles), pain and tightness in the front of the hand, wrist and forearm. These symptoms do not have to occur simultaneously, and may only affect one finger one day and then three fingers a few days later.

If a doctor provides a carpal tunnel diagnoses and the symptoms are in the ring and little fingers, it is NOT carpal tunnel syndrome! The ulnar nerve, not the median nerve, supplies function to the ring and little finger. Repetitive strain disorders affecting these two fingers are usually either Guyon’s syndrome, entrapment of the ulnar nerve in the guyon’s canal at the wrist junction, or cubital tunnel syndrome, entrapment of the ulnar nerve at the elbow junction. This is a common mistake made by many, many physicians and is completely inexcusable as they often recommend surgery for the patient, causing the patient to undergo an unnecessary procedure, and what makes it worse, for the wrong disorder!

If symptoms of carpal tunnel syndrome do arise, doctors will recommend that a nerve conduction velocity (NCV) test or an Electromoyogram (EMG) be performed to see if carpal tunnel syndrome truly exists. These tests are often painful to the individual being tested, very expensive, and often give false positives and false negatives. This is why it is recommended that manual carpal tunnel tests be performed in order to obtain a more accurate (and much cheaper) diagnosis. Manual carpal tunnel tests take no longer than 10 minutes, have a high accuracy rate, are painless and are very cheap in comparison to the NCV and EMG tests.

The recommended manual carpal tunnel tests consist of the following:

· Phalen’s Test: The wrist is flexed for 30 to 60 seconds in order to compress the median nerve and duplicate/increase the symptoms.

· Reverse Phalen’s Test: The wrist is extended for 30 to 60 seconds in order to stretch the median nerve and duplicate/increase the symptoms. Stretching the median nerve if it is already impinged will duplicate/increase the symptoms if a patient has carpal tunnel syndrome.

· Tinnel Sign: Tapping directly over the median nerve at the wrist junction will cause carpal tunnel symptoms to exhibit themselves.

· Compression Test: Direct pressure is applied over the location of the median nerve for 30-60 seconds to see if carpal tunnel symptoms are exhibited.

If a positive diagnosis comes back, most doctors will push for surgery, a procedure that has a terrible success rate and is to only be performed as a last resort once all other conservative treatment methods have been utilized. Conservative therapy is the key to successfully recovering from carpal tunnel syndrome and obtaining not only short-term but long-term relief as well. The following is a list of conservative treatments that should be utilized in order to help prevent carpal tunnel syndrome from developing, but also rehabilitating carpal tunnel syndrome after it is already present.

· Ergonomics: Utilize proper ergonomic tools and equipment when working.

· Breaks: Take short breaks every 30 minutes when working in order to help reduce excessive strain on the hands.

· Stretches: Stretch the muscles that ‘close’ the hands as these are the muscles that are exercised all day long in activities such as typing, writing, gripping a steering wheel, using a computer mouse, carrying groceries and everything else that is done day in and day out. When a muscle is involved in exercise, it becomes shorter, therefore it needs to be stretched and lengthened both during and after the exercises are completed. (End of day)

· Exercises: Exercise and strengthen the muscles that are used to ‘open’ the hands, as these muscles do not receive much direct stimuli / exercise. (i.e. People do not turn doorknobs, hold things, type, use a computer mouse or lift things with the backs of their hands.)

The information provided above reveals how carpal tunnel syndrome occurs, what its symptoms are, the testing methods most commonly used and the best conservative treatment options that are used to thwart its existence.

It is very important for individuals to become well acquainted with the proper information and tools in order to maintain and increase their level of health and productivity. It is also important for people to speak to their doctors regarding their health concerns, and if someone is involved in an occupation that is considered high-risk for carpal tunnel, they should discuss this with their physician, but is even more critical that people become self educated as no one can take care of you better than “YOU”!

Carpal tunnel syndrome is by far the most common and widely known of the “pinched nerve” conditions. This article addresses: What is it? Who is at risk for this condition? How is it diagnosed? What kinds of treatments work best?

Carpal tunnel syndrome refers to symptoms caused by entrapment of the median nerve in the carpal tunnel. “Carpal” itself means “wrist,” so a carpal tunnel is nothing more than a wrist tunnel. This particular tunnel can be a crowded place, as it contains not just the median nerve, but nine tendons as well. The “syndrome” consists of some combination of pain, numbness and weakness.

Pain, numbness, or both, are the usual earliest symptoms of carpal tunnel syndrome. Pain can affect the fingers, hand, wrist and forearm, but not usually the upper arm or shoulder. Numbness affects the palm side of the thumb and fingers, but usually spares the little finger because it’s connected to a different nerve.

When weakness is present, it usually indicates that the condition is already severe, and when muscles atrophy (wither) it means the condition is even worse. The affected muscles are those downstream from where the nerve is pinched, and can include those controlling any of three motions of the thumb. In addition, bending of the first knuckles of the index and middle fingers can be affected, as can straightening of the second knuckles of the same fingers. When muscle atrophy is present, it is most evident in the muscular ball at the base of the thumb.

Carpal tunnel syndrome occurs more frequently in women than in men. People who work with their hands a lot – for example to sew, operate hand-tools or perform assembly-line work – are at increased risk for developing this condition. Various medical conditions can also increase the risk of carpal tunnel syndrome, including injuries, arthritis, diabetes, low levels of thyroid hormone and pregnancy. In the case of pregnancy, carpal tunnel syndrome often appears in the third trimester and resolves after the woman delivers.

Optimum diagnosis of this condition combines the time-honored methods of a doctor’s history-taking and physical examination with tests of nerve function called nerve conduction studies. Nerve conduction studies are exquisitely sensitive in detecting impairment of the median nerve at the wrist, particularly when the median nerve is compared with a nearby healthy nerve in the same patient.

In nerve conduction studies, the nerve on one side of the carpal tunnel is activated by a small shock to the skin. An oscilloscope measures how long it takes for the resulting nerve-impulse to arrive on the other side of the carpal tunnel. When the median nerve is pinched, the nerve-impulse is delayed or blocked. Nerve conduction studies are so sensitive that sometimes they show problems that aren’t even causing symptoms. That’s why nerve conduction studies don’t stand alone in diagnosing carpal tunnel syndrome. The examining physician needs to decide if the results make sense for the particular patient in question.

Nerve conduction studies not only show whether or not the median nerve is impaired at the wrist, but also provide precise data concerning how bad the impairment is. In addition, these studies survey the function of other nerves in the arm and hand. Occasionally, a nerve in an adjacent tunnel (the ulnar nerve in Guyon’s canal) can also be pinched. In other cases, nerve conduction studies show that the problem is not one of single nerve-pinches, but rather a more diffuse pattern of nerve-impairment called polyneuropathy. Of course, sometimes the studies are completely normal and suggest that the symptoms are due to something else.

To treat carpal tunnel syndrome, starting with “conservative” treatment makes sense in most cases, especially when the symptoms are still in the mild-to-moderate range. Conservative treatment usually includes a wrist-splint that holds the wrist in a neutral position. In a study published in 2005 researchers at the University of Michigan investigated the effectiveness of wrist-splinting for carpal tunnel syndrome in workers at a Midwestern auto plant. In a randomized, controlled trial -  the gold standard method for judging treatments – about half the workers received customized wrist-splints that they wore at night for six weeks. The remaining workers received education about safe workplace procedures, but no splints. After treatment the workers with splints had less pain than those without, and the difference in outcome was still evident after one year.

Conservative treatment might additionally include use of anti-inflammatory medications like aspirin or naproxen, or even steroid drugs. A more intrusive, though still non-surgical, treatment consists of injecting steroid medication into the carpal tunnel itself. This might benefit selected patients, but in a 2005 randomized, controlled study of patients with mild-to-moderate symptoms, researchers at Mersin University in Turkey showed that patients receiving splints did better than those who received steroid injections.

Surgeons can relieve pressure on a pinched median nerve by cutting a constricting, overlying band of tissue. A 2002 study at Vrije University in Amsterdam compared surgical treatment to six weeks of wrist-splinting. After 18 months 90% of the operated patients had a successful outcome compared with 75% in the splinted group.

In some cases it can be reasonable to try conservative treatments without first confirming the diagnosis with nerve conduction studies. However, in the author’s opinion, this risk-free form of testing should be performed prior to any carpal tunnel surgery. (Full disclosure: The author performs nerve conduction studies!)

(C) 2005 by Gary Cordingley

Massage therapy eases the symptoms of carpal tunnel syndrome and increases grip strength, according to a recent study.

“Carpal tunnel syndrome symptoms are lessened following massage therapy” was conducted by staff at the Touch Research Institutes at the University of Miami School of Medicine in Miami, Florida.

Symptoms of carpal tunnel syndrome include pain, tingling, burning and numbness of the hand. Sixteen people diagnosed with this syndrome participated in the study. All of them held jobs involving heavy word processing or computer work.

Subjects were randomly assigned to either the standard-treatment control group or the massage-therapy group. Those in the massage group received one massage per week on the affected arm for four weeks. They were also instructed in self-massage, which they were to perform each night before bed.

The massage routine consisted of stroking of moderate pressure from the fingertips to the elbow. A massage and pain log was kept by subjects in the massage group. In the log, participants recorded the times at which they began and ended self-massage, as well as their levels of pain on a scale from zero to 10.

Subjects in the control group received no intervention, but were taught the massage routine after the study ended.

Physicians evaluated participants’ carpal tunnel symptoms, such as tingling, numbness, pain and strength, at the beginning and end of the four-week study. The Tinel sign, which tests to see if light tapping of the affected area elicits pain or tingling, was also used at the start and finish of the study. Physicians used the Phalen Test at the beginning and end of the study as well. The Phalen Test involves flexing of the wrists to see if numbness or tingling occurs.

A nerve conduction test was also performed at the start and finish of the study. This involved stimulation of the median sensory nerves through electrodes placed on each subject’s index finger and wrist. Peak sensory latencies were recorded to test for nerve compression at the carpal tunnel. Median peak latency was the primary outcome measure.

Assessments were also made before and after the massage sessions on the first and last days of the study, including the Perceived Grip Strength Scale; VITAS, a pain assessment using a visual analogue scale; the state anxiety inventory; and the Profile of Mood States.

Results of the study showed that the subjects in the massage group had significantly less pain and reduced carpal tunnel symptoms, as well as shorter median peak latencies and increased grip strength.

“Functional activity also improved as noted in reduced pain and increased grip strength in the massage therapy group, both immediately after the first and last massage therapy sessions and by the end of the study,” state the study’s authors. “Finally, the massage therapy group reported lower anxiety and depressed mood levels both immediately after the first and last sessions and by the end of the study.”