To better understand carpal tunnel syndrome (CTS), it helps to know how a
normally functioning wrist works.
The carpal tunnel is an opening into the hand comprised of the wrist bones
(on the bottom) and the transverse carpal ligament (on the top). The structure
looks similar to a subway tunnel, the bones forming the rails and the ligament
forming the arch.
Both the median nerve and the flexor tendons run through this tunnel. The
median nerve supplies sensation to the thumb, index, and middle fingers, as well
as part of the ring finger. The flexor tendons allow us to grasp objects.
As mentioned in the About section, problems begin when there's increased
pressure on the tunnel, which compresses the structures within. This can occur
when people perform activities, like typing, that involve prolonged wrist
flexion (bending the wrist upward when the palm is facing up, as if you were
lifting a table) and extension (bending the wrist upward when the palm is facing
down, as if you were waving to a friend), which cause inflammation of the
tendons. The inflammation, in turn, causes swelling in the tenosynovium, which
is a normally smooth coating that allows tendons to glide together.
Other factors, like pregnancy, obesity, rheumatoid arthritis and thyroid
disease can also predispose people to swelling in the carpal tunnel. Regardless
of the cause, however, chiropractic care offers safe and effective management
for the condition. Some underlying medical factors may necessitate medical
intervention, however, in which case your chiropractor can make an appropriate
referral.
Most people with carpal tunnel syndrome (CTS) experience significant relief
after getting chiropractic care. Chiropractors provide safe, conservative
techniques that are highly effective in relieving pain and reducing swelling in
patients' wrists and forearms.
When you first visit your chiropractor, he or she will likely focus on
determining the cause of your condition and what lifestyle factors are
contributing to your problem. Once these are established, your chiropractor will
implement a suitable management plan that will probably consist of adjustments,
soft-tissue therapy, physiotherapeutic treatments and nutritional
counseling.
The first technique your chiropractor may perform is an adjustment to your
carpal bones. As discussed in the Anatomy section, the carpal bones and
transverse carpal ligament comprise the carpal tunnel, through which the tendons
and median nerve pass into the hand. If any of the carpal bones are out of
position, it can compress the median nerve and cause added pain. By adjusting
the bones, your chiropractor can put them back in their correct place and
relieve pressure on the nerve.
Soft-tissue therapy may also be necessary. With repetitive bouts of CTS, the
tendons, ligaments and muscles associated with the wrist joint can become tight
and scarred. If the tissue in your wrist or forearm is damaged, your body will
produce extra tissue, called scar tissue, to compensate. This tissue is stiff
and inflexible, making regular movement difficult and uncomfortable. To break it
down and allow healthy tissue to grow in its place, your chiropractor may use a
technique called myofascial release, which involves sliding his or her hands
over your wrist and forearm while applying pressure.
Once the bones are in their proper place and your chiropractor has removed
scar tissue, he or she may want to use physiotherapeutic modalities like
ultrasound to relieve pain and promote healing. Ultrasound refers to any sound
wave that has a frequency above the range the human ear can perceive. To produce
these waves, chiropractors use a machine that channels electricity through a
crystal located at the end of an applicator. The crystal vibrates in response to
electricity, and the machine allows users to alter the electrical current to
affect the waves' frequency. Depending on the frequency, this can increase blood
flow, decrease pain, reduce muscle spasm, lessen nerve root irritation and speed
healing.
To further reduce pain, your chiropractor may recommend you wear a wrist
splint. Wrist splints hold the hand in a slightly raised position, which helps
relieve pressure on the carpal tunnel. Patients should make sure, however, that
the splint doesn't put more pressure on the carpal tunnel, affect grip strength
or impede fist clenching.
Proper nutrition can also help, and research shows that vitamin B6 can reduce
symptoms of CTS, especially among pregnant women who are at a higher risk of B6
deficiency. The usual dosage is around 50 to 100 mg for a minimum of one month,
but patients taking vitamin B6, especially pregnant women, should have their
chiropractor closely monitor their supplement intake.
Usually, conservative techniques like these will help patients overcome CTS,
but sometimes it's necessary for them to see a medical doctor. If a coexisting
disorder, like diabetes, is contributing to your CTS, proper medical treatment
that resolves the underlying problem can be helpful.
In addition, serious CTS may require other medical interventions. Your
physician may recommend nonsteroidal anti-inflammatory drugs (NSAIDs), which
inhibit the formation of inflammatory chemicals and reduce swelling that can
compress the carpal tunnel. In extremely serious cases, physicians may also
recommend surgery, which can provide relief but will only help patients who are
suitable candidates.
Regardless of the treatment, patients unwilling to make the necessary
lifestyle changes or follow their health-care provider's advice will have
difficulty preventing a recurrence of CTS. Your chiropractor can recommend
suitable changes that can help you avoid another bout.
