Wrist pain and shooting pains into the hands are very common complaints since lots of people work on the computer all day. Even chiropractors complain of it due to all the pushing and pulling we do. At Doroski Chiropractic Neurology in the Woodbridge, Dale City Virginia area we give our patients the best information on the cause of CTS and its treatment.
Carpal Tunnel Syndrome (CTS ) is one of the most common workplace injuries. It is often associated with prolonged computer use, but it can also affect construction workers, assembly-line workers and even athletes — any profession in which a person does a lot of gripping or holding the wrist in an unnatural position. Women are three times as likely to develop CTS as men.
What is carpal tunnel syndrome?
CTS is an irritation to the median nerve as it passes through the carpal tunnel (made up of bone and soft tissue) of the wrist, explains David Benevento, DC, who practices in Folsom, Calif. “As your flexor tendons become swollen from overuse, they occupy more space in the carpal tunnel, which in turn compresses the nerve,” he adds.
There are many explanations for the development of CTS, including an injury to the wrist that causes swelling, overactivity 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.
CTS most often appears as numbness in the thumb and first two fingers, says Dr. Benevento. But symptoms can include burning, tingling, itching, weakness and/or numbness in the palm of the hand, thumb and fingers. Some sufferers of CTS describe their fingers as “useless and swollen,” even if no swelling is apparent. Weakened grip strength often makes it hard for CTS patients to form a fist or grasp small objects. Additionally, many CTS patients report that it is hard to distinguish hot from cold by touch. The symptoms of CTS generally first appear while sleeping because many people have a tendency to sleep with flexed wrists.
A CTS diagnosis is 95-percent personal history, explains Dr. Benevento. “When a patient comes in complaining of wrist pain or numbness, simply talking to him or her about daily behaviors and workplace ergonomics is often enough to determine that the pain is caused by CTS,” he says. History, plus the initial physical examination of the hands, arms, shoulders and neck, is often all that is needed for a diagnosis. There are, however, specific tests that can be done to produce the symptoms of CTS and confirm the diagnosis, including:
• Pressure provocation tests. A group of tests designed to provoke CTS symptoms by increasing the pressure on the carpal tunnel. This can be done by placing the wrist in flexed or extended positions, percussion – or tapping – over the skin of the wrist or placing a cuff on the wrist. If any of these methods produce tingling or numbness, the presence of CTS is confirmed.
This test is rated with a Sn of 1.0/Sp of 0.97 with a LR+ of 33.33 and LR- of 0.00. (PubMed, Williams, Ann Plast Surg. 1992.)
Carpal compression test. Similar to the pressure provocation tests, the carpal compression test involves the physician placing both thumbs over the median nerve in the tunnel and applying pressure for up to 30 seconds. If symptoms occur or worsen, CTS is confirmed.
This test is rated with a Sn of 0.14/Sp of 0.96 with a LR+ of 3.50 and a LR- of 0.90. (PubMed, Boland, J Clin Neurosci. 2009.)
• Laboratory tests and image studies. These tests can reveal diabetes, arthritis, fractures and other common causes of wrist and hand pain, helping to rule out CTS. Electrodiagnostic tests, such as nerve conduction velocity testing, can be used to help confirm the diagnosis of CTS. 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.
There are many other conditions that mimic the symptoms of carpal tunnel syndrome, including a pinched nerve in the neck, and certain tests, such as the nerve conduction studies, can be used to rule out these other ailments.
According to Thomas Davis, DC, lead author on a CTS clinical trial study, the best treatment of CTS is to simply “do what doctors of chiropractic do. That is, manipulate the neck and spine and then deal with the specific areas experiencing pain.” Basically, says Dr. Davis, you want to free up the structures in the wrist so that there is no pinching or compression and your nerves can pass through the tunnel.
Davis’ study, “Comparative Efficacy of Conservative Medical and Chiropractic Treatments for Carpal Tunnel Syndrome: A Randomized Clinical Trial,”1 utilized the chiropractic treatments of ultrasound, nighttime wrist supports and manipulation of the wrist, arm and spine. These techniques were compared with the medical model of ibuprofen plus a night wrist splint. While both groups had similar results, the potential side effects of ibuprofen on the stomach, liver and kidneys led the authors to conclude that a strong argument can be made for the non-drug, chiropractic approach.
“Cold lasers weren’t available during the time of the study [published in 1997], but I would include them in my treatment of CTS today,” says Dr. Davis. “I also prescribe at-home wrist flexion stretches for patients to help get a free nerve flow through the wrist.”
Dr. Benevento agrees and adds that soft-tissue work such as ART® or Graston® can help release flexor tendons to alleviate nerve compression. He has also seen positive results with median nerve flossing or gliding (basically moving or stretching the nerve to try to free it from tight muscles or scar tissue), and it’s something that patients can do for themselves at home. “Kinesiology taping can also be helpful to keep wrists in the proper position and to alleviate swelling during the inflammatory process,” he continues.
Because carpal tunnel syndrome can stem from poor workplace ergonomics such as a forward head posture, Dr. Benevento notes that patients are more susceptible to CTS after they’ve experienced it once, especially if they do not make the necessary ergonomic changes to their work spaces. He makes a point of addressing head posture and workplace ergonomics. “It’s important to get the patient’s head back over his or her shoulders while sitting at a computer. Additionally, the patient’s palms should be parallel to the ground when typing. I advise my patients to be conscious of their posture while at work and to take frequent breaks to stand up and stretch,” he says.
1. Davis PT, Hulbert JR, Kassak KM, et al. “Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trial.” J Manipulative Physiol Ther. 21.5 (June 1997): 317-326.
Many workers spend countless hours in front of computers barely ever changing position. Here are some tips to share with patients to help prevent injuries, such as carpal tunnel syndrome:
• Your feet should be touching the floor, with the legs and body forming an angle of 90 to 110 degrees.
• Adjust the height of your monitor. Look forward with your head in a neutral position. Your eyes should be at the same height as the top of the monitor.
• When talking on the phone, use a headset, when possible, especially if you talk on the phone for prolonged periods.
• Find a mouse that fits your hand, and then slide your palm up to rest on the mouse and use your whole arm to move the mouse when possible.
• If you rest your wrist on the desk for extended periods, consider using a soft gel pad to minimize pressure on the carpal tunnel.
• You should be able to use your mouse with your elbow at your side and your hand directly in front of you. Try a keyboard that has a separate number pad or one that is on the left of the keyboard, which frees up space on the right for the mouse.
For the latest research on CTS, see:
1. Brantingham JW, Cassa TK, Bonnefin D, Pribicevic M, Robb A, Pollard H, et al. Manipulative and multimodal therapy for upper extremity and temporomandibular disorders: a systematic review. J Manipulative Physiol Ther. Elsevier; 2013 Mar;36(3):143-201.
2. Burke J, Buchberger DJ, Carey-Loghmani MT, Dougherty PE, Greco DS, Dishman JD. A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. J Manipulative Physiol Ther. 2007 Jan;30(1):50-61.
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Woodbridge VA 22192
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