Wellness.MA
Wellness.Massachusetts

CARPAL TUNNEL SYNDROME
CONSERVATIVE TREATMENT AND PREVENTION

Dr. Scott Fuller, D.C., C.C.S.T.

Carpal Tunnel Syndrome costs billions of dollars in treatment and lost work time each year and causes undo stress and suffering to millions of people. However, Carpal Tunnel Syndrome (CTS) may be commonly misdiagnosed and therefore mistreated.

A true CTS is when the nerve that runs down the middle of the forearm and wrist, called the median nerve, is compressed by a ligament that stretches across it at the level of the wrist. When this ligament compresses the median nerve, this may lead to pain and tingling in the hands, fingers, and wrist, but the pain may radiate up the arm, and in some cases, all the way to the shoulder and neck. In other cases, some people may suffer from swollen, cold, and clammy hands and fingers, and complain of weakness with various activities such as typing, unscrewing a jar lid, or turning a doorknob.

Clinically, health care professionals can utilize several different tests to diagnose CTS or diagnose some other problem that may cause similar symptoms as CTS. When the median nerve reaches the wrist, it splits into two branches called roots. The motor root contains nerves that control some of the small muscles, blood vessels, and glands of the hand. This root passes beneath the flexor retinaculum ligament of the wrist and is susceptible to compression. One muscle of the thumb in particular becomes affected with CTS. This muscle is called the abductor pollicus brevis, and it moves the thumb away from the index finger when it is working properly. Weakness of this muscle either detected upon examination or with an electrical diagnostic test, can help confirm or deny the presence of CTS. Other nerves in this motor root control blood vessels and sweat glands in the hand and fingers. With nerve compression in CTS, these nerve fibers also become compressed, which can lead to the swollen, cold, and clammy hands and fingers that many people experience.

What causes the pain?

Pain, weakness, and other symptoms experienced by CTS sufferers are also caused by the compression of the median nerve by the flexor retinaculum. When a nerve is compressed, the tissues that the nerve supplies are deprived of nutrients and stimulation crucial to their health. These tissues, such as muscles and blood vessels, begin to become dysfunctional and break down. Chemicals and waste products begin to accumulate, which stimulate pain nerves to send pain messages to the brain for the perception of pain. The other branch, or root, of the median nerve that carries these pain messages from the hand to the brain is unaffected by CTS. This sensory root passes ABOVE the wrist ligament (flexor retinaculum) and it is commonly not compressed in CTS. So when pain nerves are stimulated from the irritated tissues and collected chemicals, they can send the pain messages to the brain along the uncompressed pathway.

Compression of the median nerve can occur at other locations along its pathway, such as the pronator teres muscle (elbow) and the scalene muscles (neck). These compression sites can give symptoms mimicking CTS, so a proper diagnosis is crucial before treatment begins. In many cases a proper diagnosis can be formulated by a failed CTS surgery. If CTS surgery is performed in the flexor retinaculum area, and the desired clinical result is not achieved, it is possible that the lesion exists elsewhere. Due to the inherent side effects of surgery and the high failure rate of CTS surgeries in particular, other less invasive treatments should be exhausted first after the proper diagnosis is made.

How does compression initially begin?

One common cause occurs when the muscles on the front part of the arm are too tight. These muscles are kept at their proper tone by the cortex (brain). If the cortex is functionally properly, it will control the tightness or tone of the front forearm muscles, called flexors. When the cortex is not functioning properly, the flexor muscles will remain in a tightened, higher tone state, which draws the median nerve closer to the flexor retinaculum, causing compression and CTS. In addition, typical daily work and home activities strengthen the flexor (front) muscles of the forearm, weakening the extensor (back) muscles of the forearm, causing a further imbalance, wrist flexion, and more median nerve compression.

Proper functioning of the brain is imperative in the treatment and prevention of CTS. One of the most important sources of input to the brain that keeps it functioning well comes from specialized nerve sensors in the spinal joints. These nerve sensors, called mechanoreceptors, depend on spinal joint health and flexibility to stimulate the brain. When spinal joint health is lost, especially in the neck, these nerve sensors do not stimulate the brain. The brain then cannot regulate the tone of the forearm muscles, and CTS may result. Chiropractic care is designed to improve spinal and extremity joint health, and increase the firing of mechanoreceptors, to improve cortical output. In cases of CTS, a chiropractor may employ certain adjustments and manipulations of joints, tendons, and muscles in the upper extremity to assist recovery. Chiropractors like Dr. Fuller teach home exercises to counteract the strong flexor muscles and weak extensor muscles. Improved posture habits may also reduce future problems by improving the overall health of the spine, especially the neck, and stimulate the cortex, which will have a greater ability to regulate the tone of the flexor and extensor muscles of the arms.


What can you do now for home treatment?

1. Raise computer monitors ABOVE eye level.
   (NOTE: Perform the exercises listed here under the supervision of your health care practitioner)
2. Perform reverse wrist curls to strengthen the back (extensor) muscles of the forearm.
3. Perform the rubber band exercise: Place an average sized rubber band around your distal fingertips. Hold your fingers almost straight, with a slight bend, in a claw-like position. Open the fingers slowly as far open as you comfortably can against the tension of the rubber band, then relax your fingers to the start position, making sure you keep a little tension on the rubber band even in the start position. Start with a couple of sets of 10 repetitions per day, and increase to several sets per day as you see fit. You can do these exercises in various locations: the car, at work, at home. Carry rubber bands with you and increase/decrease the size of the band if needed. If you are getting stronger, increase to 2 rubber bands.
4. Perform specific spinal extension and flexibility exercises daily.
5. Avoid slumped over, round-shouldered, chin-down postures for long periods.
6. Get out of your chair frequently.
7. If symptoms persist, consult a chiropractor to see if chiropractic care can help.
   
   

Created by: Dr. Scott Fuller, D.C., C.C.S.T.
Fuller Chiropractic
576 Main Street
Woburn, MA 01801

(781) 933-3332

[ Next ]

[ Home ] [ Diet ] [ Adult Fitness ] [ Sports Fitness ] [ Senior Fitness ] [ Youth Fitness ] [ Prevention ] [ Stress ] [ Health Conditions ] [ Wellness Resources ] [ About ] [ Contact ]