Carpal Tunnel Syndrome
Dr. Bill Pohlen, Total Health Systems, Macomb County
It never fails, someone will share that they are experiencing pain or numbness in their wrist, hand or fingers and someone will diagnose that person with Carpal Tunnel Syndrome! When in reality it is most likely Carpal Tunnel like symptoms. To better understand what takes place in CTS (Carpal Tunnel Syndrome) let’s start with the anatomy of the wrist.
The wrist is made up of 8 bones and arranged in two rows. These two rows of wrist bones are tightly held together by interosseous ligaments and make up the boney structures of the carpal tunnel. The actual carpal tunnel is found on the palm side of the wrist with its contents being comprised of the flexor tendons of the fingers and hand, the median nerve, and the transverse ligament that makes up the roof of the carpal tunnel. It is not common knowledge that there is actually another tunnel found on the little finger side of the palm called the tunnel of guyon which is the location of the ulnar nerve as it passes through to its end point of the little finger side of the palm. The ulnar nerve is also found in a more common location called the cubital tunnel located on the inside of the elbow and is more commonly known at the “funny bone” nerve.
Carpal tunnel Syndrome by definition is a painful condition of the hand and fingers caused by compression of a major nerve (Median Nerve) where it passes over the carpal bones through a passage at the front of the wrist, alongside the flexor tendons of the fingers and hand.
Some Carpal Tunnel Syndrome causes range from biomechanical forces which decrease the size of the carpal tunnel increasing pressure on the median nerve. Usually the result of repetitious strain or forces of impact with the hands bent in awkward positions for prolonged periods and/ or fast paces. Other Carpal Tunnel Syndrome causes include fluid retention, oral contraceptives, pregnancy, obesity, diabetes, hypothyroidism, Reynaud’s, tenosnyovitis, rheumatoid arthritis, multiple myeloma, and hemodialysis, swelling and edema. Local Carpal Tunnel Syndrome causes include fractures, dislocations, palmar or dorsal bony displacement stretching the nerve, vigorous repetitive wrist flexion/extension and deviation.
Symptoms usually start gradually, with frequent burning, tingling, or itching numbness in the palm of the hand and fingers, especially the thumb and the index and middle fingers as seen in this diagram. The symptoms often first appear in one or both hands during the night, since many people sleep with flexed wrists. A person with carpal tunnel syndrome may wake up feeling the need to “shake out” the hand or wrist. If the symptoms worsen, people might feel tingling during the day, decreased grip strength may make it difficult to form a fist, grasp small objects or perform other manual tasks. In cases that go untreated and become chronic, the muscles at the base of the thumb may become smaller and people may be unable to tell the difference between hot and cold by touch.
An early diagnosis of Carpal Tunnel Syndrome is important to avoid permanent damage to the median nerve. An examination of the hands, arms shoulders and neck can help determine if the patient’s complaints are related to daily activities or to an underlying disorder and can rule out other painful conditions that mimic carpal tunnel syndrome. The wrist is examined for tenderness, swelling, warmth and discoloration. Each finger will be tested for sensation, and muscles at the base of the hand should be examined for strength and signs of atrophy. Your doctor will use specific tests to try and reproduce symptoms of carpal tunnel syndrome.
Tinel’s test will require the doctor to tap on or press on the median nerve in the patient’s wrist. The test is positive when tingling in the fingers or a shock like sensation occurs. Phalen’s or wrist-flexion test involves having the patient hold their forearms upright by pointing the fingers down and pressing the backs of the hands together. Carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increased numbness, are felt in the fingers within 1 minute.
To confirm the diagnosis an electrodiagnostic test is performed to test nerve conduction. In this study electrodes are placed on the hand and wrist. Small electric shocks are applied and the speed with which nerves transmit impulses is measured.
Once carpal tunnel syndrome is diagnosed treatment should begin as soon as possible.
Carpal tunnel release surgery is the most common surgical procedure in the US. As you can see in the diagram it involves cutting the transverse ligament. This is done to reduce the pressure on the median nerve.
Endoscopic surgery may allow for faster recovery but cutting the transverse ligament is still the end result.
Although symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery may take months. Some patients may have infection, nerve damage, stiffness, and pain in the scar. Occasionally the wrist loses strength because the transverse ligament is cut. Some patients may need to adjust job duties or even change jobs after recovery from surgery and at all costs surgery should be the last method of treatment for carpal tunnel syndrome.
A more conservative treatment plan is used at Total Health Systems of Macomb County. This initially involves resting the involved wrist for at least 2 weeks, avoiding activities that would aggravate the symptoms and using ice to reduce any swelling that might be present. Taking Vitamin B6 has also been shown to ease the symptoms of carpal tunnel syndrome. Stretching and strengthening exercises can be helpful when the symptoms have decreased or stopped. Exercise maybe supervised by a physical therapist, which is trained to use exercises to treat physical impairments. Chiropractic care should also be incorporated into the treatment regime to remove subluxations in the wrist that may be causing irritation to the carpal tunnel or the median nerve itself. Our Total Health Systems Chiropractors, Medical Doctors and Physical Therapists are trained to diagnose, treat and rehabilitate carpal tunnel and many other conditions and keep you on the path to good Health.
Reference: “Carpal Tunnel Syndrome Fact Sheet,” NINDS. Publication date November 2002. NIH Publication No. 03-4898
Reference Dr. Mitch Mally. “Carpal Tunnel Syndrome and Other Cumulative Trama Disorders”