You have pain in your wrist. Its been like this for a while, but you ignore it and hope it just goes away. It gets worse when you hold the computer mouse at work. Your thumb and index finger have been going numb lately and you almost dropped your coffee cup again this morning! The pain keeps waking you up at night and it's starting to make its way up your arm. And why do you have that neck pain and tension across the top of your shoulders? Could you have carpal tunnel syndrome?
Carpal tunnel syndrome (CTS) is the most common injury suffered by workers in an office environment. According to the Bureau of Labor Statistics, "disorders associated with repeated trauma account for about 60 percent of all occupational illnesses." Of all these disorders, carpal tunnel syndrome is the condition most frequently reported. What, exactly, is "carpal tunnel"? What are the causes and what are some effective treatment options? Are there any options besides surgery?
Carpus is a word that is derived from the Greek word "carpos", which means "wrist". The wrist is made up of 8 individually moving bones called the carpals. They are surrounded by a fibrous band of tissue that supports them, called the transverse carpal ligament. Together, these bones and the ligament, form a tunnel for the median nerve to pass through. Irritation to the median nerve causes numbness, tingling, pain, and weakness of the wrist, thumb, index, and middle fingers, which, as some of you will attest, can be quite debilitating. I've heard some of my patients with this condition say that it decreases their productivity at work, keeps them awake at night, and even causes them to drop things (like, heaven forbid, their coffee cup!). So, how does the median nerve get irritated? Let's explore two of the most common reasons.
Each of the carpal bones in the wrist is designed to move individually. One or more of these joints can become stuck like a couple of suction cups. This is usually due to repetitive stress injuries which occur during such activities as typing and use of a computer mouse for prolonged periods. When the joints get stuck, the joint surfaces become irritated (a.k.a. arthritis) and the soft tissues that surround the joints become inflamed and swollen. It's this swelling into the tight space of the carpal tunnel that causes compression and irritation of the median nerve. Therefore, it is logical to assume that if we can restore normal motion to the individual joints of the wrist, the swelling and inflammation will resolve, the nerve will be decompressed, and the symptoms will be relieved.
Research is proving this to be the case. One study published in the journal Manual Therapy (by Tal-Akabi A, Rushton A., 2000 Nov; 5(4):214-22, Bern Switzerland) shows that, on average, chronic carpal tunnel syndrome patients get 70% improvement in their symptoms following three weeks of specific wrist manipulation. It also demonstrated that 86% of the control group (the group that did not receive any manipulative treatment) went on to have their scheduled surgery, whereas only 14% of the group who received manipulative therapy, went on to have their scheduled surgery. Therefore, while a small percent of patients may still need surgery, it makes sense to try an effective, less painful, and much safer conservative treatment, like specific wrist manipulation, before making the trip to the surgeon.
But, that isn't the whole story. The nerves that exit between the joints of the lower region of the neck and upper back control all of the functions of the shoulders, arms, wrists, and fingers. Where these nerves exit between the neck bones is the first place that there can be interference between the brain's communications with the arms. Like vines that form smaller branches, these spinal nerves extend through the arms to the wrist and hand, one of which becomes the median nerve. It is vitally important that we trace any form of interference back to its source, usually at the spine; otherwise results from any form of treatment will only be temporary. Like the wrist bones, the spinal joints also need to move individually. Otherwise, inflammation and swelling of the soft tissues around the joint can cause pinching, choking, or irritation of the spinal nerves, which can cause pain, numbness, tingling, or weakness anywhere along the branches of the shoulder, arm, wrist, or hand. That is why it is so important to have your neck examined and treated, as well as your wrist.
Chiropractors are doctors who specialize in the restoration of normal joint motion, most commonly in the spine. Some chiropractors also perform specific manipulation of the extremities, such as the shoulders, elbows, wrists, and fingers. To treat carpal tunnel syndrome most effectively, I suggest you find a chiropractor who manipulates extremities as well as the spine. Also, ask your potential chiropractor if they perform exercise therapy, utilize therapeutic modalities such as electric muscle stimulation and cervical traction, and prescribe nutritional supplements to help treat your condition. In my experience, a well-rounded approach will give you the best chance of faster, longer lasting relief.
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