Saturday, July 20, 2013

Hand Numbness, Tingling, Pain or Weakness? Carpal Tunnel Syndrome Diagnosis and Treatment Options


Carpal Tunnel Syndrome is a condition in which the median nerve is impinged, most often at a point in the wrist where it passes through a narrow tunnel-like opening known as the carpal tunnel. This opening is formed by the transverse carpal ligament as well as the hammate and pisiform bones in the wrist.

Symptoms of Carpal Tunnel Syndrome include:

• Numbness or tingling in the thumb, index, middle finger and possibly part of the ring finger

• Pain in the wrist or hand

• Poor grip strength (trouble lifting and carrying items) or weakness in the wrist and hand

• Difficulty moving the fingers and wrist

• Muscle atrophy

If you have been suffering from any of the above symptoms, it is a good idea to determine whether it is because of Carpal Tunnel Syndrome. Although it is best to see a doctor for a definitive diagnosis, there are some quick tests you can try at home.

1. Tinel's Sign: Hold your symptomatic hand out with the palm facing upward. Tap firmly and quickly on the center of the wrist crease for several seconds. If this tapping aggravates your symptoms, it's likely to be Carpal Tunnel Syndrome.

2. Phalen's Test: Press the backs of your hands together (with the elbows bent and forearms up). Fingers should be pointing down and the wrists bent at a 90 degree angle. Hold this position for one minute. Any aggravation in symptoms suggests Carpal Tunnel Syndrome.

3. Reverse Phalen's Test: Press the palms of your hands together in a prayer position and lower your wrists and forearms as far as possible without letting your hands separate. Hold this position for one minute. Again, any worsening of symptoms suggests Carpal Tunnel Syndrome.

There are many reasons why someone may develop Carpal Tunnel Syndrome. Because the carpal tunnel is a narrow space, the median nerve running through it may become entrapped if there is any inflammation, fluid, or scar tissue buildup within the tunnel. This may occur due to:

• Overuse (repetitive use may irritate the median nerve where it runs through the carpal tunnel)

• Fluid retention (such as in pregnancy)

• Obesity

• Inflammation (this includes arthritis and infections)

• Misalignment of the wrist bones, elbow, or neck and shoulder regions

• Cyst or Tumor in the wrist

Choosing the Right Treatment for You

It is imperative to educate yourself on the treatment options available to you, so that you may make an informed decision as to whether to choose allopathic medicine (most M.D.s, or Medical Doctors) or alternative medicine (Chiropractic and/or Acupuncture). Read on to understand these very different approaches, and be sure to read my recommendations at the end.

Allopathic Medicine for Carpal Tunnel:

In the traditional western medicine approach, doctors perform orthopedic, nerve conduction velocity and electromyography tests to evaluate for Carpal Tunnel Syndrome. Treatment options include wearing a brace for several weeks, taking NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as Ibuprofen or Naproxen, corticosteroid injections, and ergonomic evaluation and correction.

While ergonomic evaluation and counseling is a good idea, there are many potential problems with the other therapies in this model. Wearing a brace takes weeks and is often ineffective. Taking NSAIDs may decrease pain and inflammation, but this is a band aid rather than a solution. Moreover, long-term use of NSAIDs carries a risk of side effects and serious complications like ulcers (bleeding in the stomach or gut). Corticosteroids are also effective in minimizing inflammation, but they too fail to address what triggered the inflammation, and repeated injections may have negative consequences on the ligaments, immune system, and adrenal glands.

Taking the above measures often fails to provide relief. In fact, over 50% of people who try the above methods end up getting surgery. The surgical "solution" to this problem is to sever (cut) the transverse carpal ligament to make more room for the median nerve. Destroying this ligament destabilizes the structures within the tunnel. Although this provides relief for some, this means a period of limited use and physical therapy during the recovery. Moreover, there is always the risk that scar tissue resulting from the surgery will re-impinge the median nerve.

There are no therapies available in this model to address misalignments in the wrist bones, elbow, shoulder or neck. Most medical doctors are not trained in identifying or treating joint misalignments.

Alternative Medicine for Carpal Tunnel:

In addition to the orthopedic tests, alternative medicine doctors use palpation and muscle testing to identify the root of the problem. Expect an examination that evaluates the whole body in addition to the problem hand and wrist.

Palpation helps identify any misalignments that can irritate the median nerve. Muscle testing and biofeedback (called Professional Applied Kinesiology (PAK)) is another invaluable tool in the diagnosis and treatment of Carpal Tunnel symptoms.

Treatment options include chiropractic adjustments and acupuncture, and this may address other problem areas besides the wrist.

Chiropractic care has an impressive track record for resolving Carpal Tunnel Syndrome. Often the associated symptoms result from misalignment(s) of the wrist, elbow, shoulder, and/or neck. In such cases, chiropractic adjustments can quickly and easily remove pressure from the median nerve and restore normal joint mechanics. This eliminates pain and restores normal muscle strength. Mild soreness sometimes follows the adjustment but resolves within 24 hours.

An acupuncturist will evaluate your pulse and examine your tongue in order to determine the cause of the problem. The treatment will involve inserting a few thin, sterile needles at various points throughout the body to restore balance and provide relief. Acupuncture, supplements, and diet modification have also been effective at decreasing inflammation and providing relief for many people.

Recommendations:

1. Try Vitamin B6 if you are retaining too much fluid. This is a natural diuretic and may help.

2. If your job requires you to spend long hours at a keyboard or to do other repetitive motions for prolonged periods, get an ergonomic evaluation.

3. For one month, eliminate all sugar, sugar substitutes, and limit grains from your diet. These foods all increase inflammation and thus worsen the symptoms of Carpal Tunnel Syndrome.

4. See a chiropractor or acupuncturist specializing in Professional Applied Kinesiology (PAK) for natural treatments for your carpal tunnel syndrome. Go to icakusa.com and click on the "Find a Doctor" tab to search for someone near you.

Most people respond very well to chiropractic, acupuncture, and/or supplements and dietary measures. However, if these natural treatments fail to provide relief, the more invasive treatments offered by western medicine can be a back-up option.

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