Carpal tunnel syndrome (CTS) is the most expensive
of all work- related injuries.
Over his or her lifetime, a carpal tunnel patient
loses about $30,000 in medical bills
and time absent from work. In 1998, an estimated 3
of every 10,000 workers took
time off from work because of CTS. Half of them missed
more than IO workdays.
CTS typically occurs in adults, with women 3 times
more likely to develop it than
men. The dominant hand is usually affected first,
and the pain is typically severe.
CTS is especially common in assembly- line workers
in manufacturing, sewing,
finishing, cleaning, meat packing, and similar industries.
Contrary to the conventional
wisdom, according to recent research, people who perform
data entry at a
computer (up to 7 hours a day) are not at increased
risk of developing CTS.
What Is CTS?
CTS is a problem of the median nerve, which runs
from the forearm into the hand.
The median nerve provides sensation to the palm side
of the thumb, index, and
middle fingers and regulates the function of some
small muscles in the hand that
move the fingers and thumb. CTS occurs when the median
nerve gets compressed
in the carpal tunnel-a narrow tunnel at the wrist-made
up of bones and soft tissues,
such as nerves, tendons, ligaments, and blood vessels.
The compression may result
in pain, weakness, and/or numbness in the hand and
wrist, which radiates up into the forearm. CTS is
the most common of the "entrapment neuropathies"-compression
or trauma of the body's nerves in the hands or feet.
A similar condition in the foot is
called tarsal tunnel syndrome.
What Are the Symptoms?
Symptoms usually begin gradually. Burning, tingling,
itching, and/ or numbness in the
palm of the hand and thumb, index, and middle fingers
are most common. Some
people with CTS say that their fingers feel useless
and swollen, even though little or no swelling is
apparent. Since many people sleep with flexed wrists,
the symptoms often
first appear while sleeping. When this happens, some
people feel the need to "shake
off the numbness." As symptoms worsen, they may
feel tingling during the day. In
addition, weakened grip strength may make it difficult
to form a fist, grasp small
objects, or perform other manual tasks. Some people
develop wasting of the muscles
at the base of the thumb. Some are unable to distinguish
hot from cold by touch.
Why Does CTS Develop?
Some people have smaller carpal tunnels than others,
which makes the median nerve compression more likely.
In others, CTS can develop because of an injury to
wrist that causes swelling, over- activity of the
pituitary gland, hypothyroidism,
diabetes, inflammatory arthritis, mechanical problems
in the wrist joint, poor work ergonomics, repeated
use of vibrating hand tools, and fluid retention during
or menopause. In some cases, no cause can be identified.
How Is It Diagnosed?
To avoid permanent damage to the median nerve, CTS
should be diagnosed and
treated early. A standard physical examination of
the hands, arms, shoulders, and
neck can help determine if your symptoms are related
to daily activities or to an
underlying disorder. Your doctor of chiropractic can
use other specific tests to try to produce the symptoms
of carpal tunnel syndrome. The most common are:
* Pressure-provocative test. A cuff placed at the
front of the carpal tunnel is inflated, followed by
direct pressure on the median nerve.
* Carpal compression test. Moderate pressure is applied
with both thumbs directly
on the carpal tunnel and underlying median nerve at
the transverse carpal ligament.
The test is relatively new.
Laboratory tests and x-rays can reveal diabetes,
arthritis, fractures, and other
common causes of wrist and hand pain. Sometimes electrodiagnostic
tests, such as
nerve conduction velocity testing, are used to help
confirm the diagnosis. With these
tests, small electrodes, placed on your skin, measure
the speed at which electrical
impulses travel across your wrist. CTS will slow the
speed of the impulses and will
point your doctor of chiropractic to this diagnosis.
These tests can also help determine
if some other condition is causing your complaints.
What Is the CTS Treatment?
CTS treatment should begin as early as possible under
a doctor's supervision. Initial
* Resting the affected hand and wrist
* Avoiding activities that may worsen symptoms
* Immobilizing the wrist in a splint to avoid further
damage from twisting or bending
* Applying cool packs to help reduce swelling from
Some medications can help with pain control and inflammation.
Studies have shown that vitamin Ek supplements may
relieve CTS symptoms.
Chiropractic joint manipulation and mobilization
of the wrist and hand, stretching
and strengthening exercises, soft-tissue mobilization
techniques, and even yoga can
be helpful. Scientists are also investigating other
therapies, such as acupuncture, that
may help prevent and treat this disorder. Your doctor
of chiropractic can discuss
those therapies with you and help you prevent the
return of CTS.
Occasionally, patients whose symptoms fail to respond
to conservative care may
require surgery. The surgeon releases the ligament
covering the carpal tunnel. Today,
this outpatient procedure is typically done with an
endoscope-a camera that the
surgeon uses to see inside the carpal tunnel. The
majority of patients recover
completely after treatment, and the recurrence rate
is low. Proper posture and
movement as instructed by your doctor of chiropractic
can help prevent CTS
How Can CTS Be Prevented?
The American Chiropractic Association recommends
the following tips:
* Perform on-the-job conditioning, such as stretching
and light exercises.
* Take frequent rest breaks.
* Wear splints to help keep the wrists straight.
* Use fingerless gloves to help keep the hands warm
* Use correct posture and wrist position. If needed,
your doctor of chiropractic
can assess your work situation and advise you on restructuring
job tasks, and handling tools or tool handles, to
help you position your wrists
naturally during work.
* Your doctor of chiropractic can help educate your
employer about CTS. To
minimize workplace injuries, jobs can be rotated among
workers. Employers can
also develop programs in ergonomics-the process of
adapting workplace conditions
and job demands to workers' physical capabilities.
Your doctor of chiropractic has the knowledge, training,
and expertise to help you understand what your problem
is and, in many cases, manage it successfully.
Remember, however, that the treatment program can
be successful only with your
active participation. If your doctor of chiropractic
feels that he or she cannot help
you, he or she will direct you to another health care
It is not uncommon for pregnant women to suffer the
effects of carpal tunnel
syndrome. This is due to the hormonal changes and
increased edema (fluid) in the extremities. Subluxation
plays a major role in the formation of carpal tunnel
ICA International Review of Chiropractic, Jan./Feb.
Since 1985, when the U. S. Occupational Safety and
(OSHA) accepted that there were "traumatogens"
in the workplace and demanded
that repetitive motion disorders be reported, the
recorded incidence of cumulative
trauma disorders has skyrocketed (Figure 3). About
277,000 cases were reported
in 1997, compared with fewer than 50,000 in 1985.
CTS has been the fastest
growing category, recently accounting for more than
40% of all work-related
disabilities. An estimated 26,000 CTS patients in
the United States undergo surgical decompression each
year. Median time lost from work is about 32 days
patient, more than for any other cause, including
Source: US Department of Labor
Take some positive steps toward a having a pain-free
life. Call today for an appointment.