What Is CTS?
CTS is a problem of
the median nerve, which runs from the forearm into the hand. 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.
What Are the Symptoms?
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. As symptoms worsen, they may
feel tingling during the day. In addition, weakened grip strength may
make it difficult to form a fist or grasp small objects. 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 the 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 pregnancy or menopause.
How Is It Diagnosed?
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 nerveconduction 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.
What Is the CTS Treatment?
Initial therapy includes:
• 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 inflammations Some
medications can help with pain control and inflammation. Studies have
shown that vitamin B6 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. Occasionally, patients whose symptoms
fail to respond to conservative care may require surgery. The surgeon
releases the ligament covering 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 recurrences.
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 and flexible.
• Use correct posture and wrist position.
• 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.