Carpal Tunnel Syndrome (CTS) belongs to a group of disorders referred to as “cumulative trauma disorders,” or CTDs. The word “cumulative” refers to the cause being repetitive motion, usually fast and prolonged. Over time, the wear and tear on the upper extremities accumulates and symptoms begin to occur and possibly worsen. This can result in changes in movement intended to avoid further injury that then overstress another part of the arm, which can lead to a second injury. Like dominos, injury after injury can eventually result in multiple conditions between the neck and hand. Let’s take a look at two of the more common CTDs…
Carpal Tunnel Syndrome (CTS) is the most well known of the CTDs because the thumb, index, third, and fourth ring finger comprise 90% of the hand’s function. This part of the hand is innervated by the median nerve that travels through the carpal tunnel at the wrist. When injured, it can make fine motor movements, like tying your shoe, difficult-to-impossible! Our grip strength is also greatly affected by a pinch of the median nerve, so dropping coffee cups, difficulty removing a gallon milk jug from the refrigerator, and the ability to lift and carry are all compromised. Some risk factors for CTS include: 1) Age over 50; 2) Female gender; 3) Obesity; 4) Working in a highly repetitive motion type of job (assembly line work, meat/poultry plants, typing); 5) The presence of other CTDs such as forearm, wrist, or hand tendonitis; and 6) Metabolic conditions such as thyroid disease (hypothyroidism), diabetes, rheumatoid arthritis, and more. Management strategies include: 1) Night use of a wrist splint (i.e., rest); 2) chiropractic manipulation of the small joints of the wrist and hand, and often, the elbow, shoulder, and neck; 3) Muscle and tendon myofascial release / mobilization techniques; 4) Management of any underlying metabolic condition (like hypothyroid disease and diabetes); and 5) Anti-inflammatory measures (ginger, turmeric, boswellia, bioflavinoids, vitamin B6, ice massage over the palm side of the wrist). NOTE: Recent studies have reported the use of NSAIDs—non-steroidal anti-inflammatory drugs like Advil (ibuprofen), Aleve (Naproxen), and aspirin—can interfere with and prolong the healing process. Chiropractic care may also include the use of modalities such as low level laser therapy, pulsed magnetic field, ultrasound, and/or electrical stimulation. Your doctor may order an EMG/NCV (electromyogram/nerve conduction velocity) if the case is not responding appropriately. Surgical intervention is the LAST RESORT but frequently, conservative chiropractic care yields satisfying results!
Cubital Tunnel Syndrome (Ulnar Nerve Entrapment – UNE): This is similar to CTS but it involves the ulnar nerve being pinched at the inner elbow (near where the “funny” bone is located). The big difference here is that the numbness/tingling involves the pinky side of the fourth and fifth fingers (NOT the thumb, index, third, or thumb-side of the fourth finger). Remember, you can have BOTH CTS and ulnar nerve entrapment (UNE) at the same time, in which case all five fingers may be involved. Causes are similar as CTS, but a more recently identified cause is called “cell phone elbow” due to the prolonged elbow flexed/bent position while using a phone. An overnight splint keeping the elbow straight as well as a wrist splint can be very effective. Otherwise, the treatment is similar to that described for CTS and it is frequently easily managed with non-surgical chiropractic care!
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