Carpal Tunnel

Convert that kitchen table to a functioning desk!

in Chiropractor  by June 16, 2022 0 comments

Working form home has been a blessing and a curse for a lot of people.  Sure, the commute is great but the desk set up is terrible.  That kitchen table desk has been a huge business builder for chiropractors.  Your Woodbridge, Dale City VA chiropractor has some tips on how to set up your home office to avoid injury.

The first step in setting up an office chair is to establish the desired height of the individual’s desk or workstation. This decision is determined primarily by the type of work to be done and by the height of the person using the office chair. The height of the desk or workstation itself can vary greatly and will require different positioning of the office chair, or a different type of ergonomic chair altogether.

Once the workstation has been situated, then the user can adjust the office chair according to his or her physical proportions. Here are the most important guidelines – distilled into a quick checklist – to help make sure that the office chair and work area are as comfortable as possible and will cause the least amount of stress to the spine:

Elbow measure

First, begin by sitting comfortably as close as possible to your desk so that your upper arms are parallel to your spine. Rest your hands on your work surface (e.g. desktop, computer keyboard). If your elbows are not at a 90-degree angle, adjust your office chair height either up or down.

Thigh measure

Check that you can easily slide your fingers under your thigh at the leading edge of the office chair. If it is too tight, you need to prop your feet up with an adjustable footrest. If you are unusually tall and there is more than a finger width between your thigh and the chair, you need to raise the desk or work surface so that you can raise the height of your office chair.

Calf measure

With your bottom pushed against the chair back, try to pass your clenched fist between the back of your calf and the front of your office chair. If you can’t do that easily, then the office chair is too deep. You will need to adjust the backrest forward, insert a low back support (such as a lumbar support cushion, a pillow or rolled up towel), or get a new office chair.

Low back support

Your bottom should be pressed against the back of your chair, and there should be a cushion that causes your lower back to arch slightly so that you don’t slump forward or slouch down in the chair as you tire over time. This low back support in the office chair is essential to minimize the load (strain) on your back. Never slump or slouch forward in the office chair, as that places extra stress on the structures in the low back, and in particular, on the lumbar discs.

Resting eye level

Close your eyes while sitting comfortably with your head facing forward. Slowly open your eyes. Your gaze should be aimed at the center of your computer screen. If your computer screen is higher or lower than your gaze, you need to either raise or lower it to reduce strain on the upper spine.

Armrest

Adjust the armrest of the office chair so that it just slightly lifts your arms at the shoulders. Use of an armrest on your office chair is important to take some of the strain off your upper spine and shoulders, and it should make you less likely to slouch forward in your chair.

 

Doroski Chiropractic Neurology

3122 Golansky Blvd, Ste 102

Woodbridge VA 22192

703 730 9588

 

Maplink

Pain in the Wrist!

in Chiropractor  by June 4, 2021 0 comments

Carpal tunnel is a fairly common wrist/hand injury.  It is usually associated with typing but you can get it from almost any overuse of the hand and forearm.  My mom got it from knitting.  Your Woodbridge, Dale City VA Chiropractor has some information to help you avoid this common injury.

The forearm and digit energizer series is a great way to manage that fatigue and pain you are feeling creep into your hands and wrists from excessive typing, gripping, or handstand walking.

This series is challenging and can place your hands into a position that they may not be comfortable being in to start, so exercise restraint on your first time. If you find your hands, wrists, or fingers are tender in any of these stretches, try first to reduce the pressure applied, and then slowly and progressively increase that pressure over time until you gain a full range of motion. We encourage you to challenge yourself with the finger flexing and neuromuscular components shown as well. You will be surprised at how much dexterity you gain from just a few round of this series, and the fatigue you feel when you first begin is expected. However, in time, when your fingers are dancing across your keyboard pain free and you suddenly are able to shuffle a deck of cards like a riverboat gambler, you will understand why we call it the energizer series!

A couple things to remember:

Complete 5-10 good reps of all the exercises shown, and take the time to slow down the movement and get a good amount of time under tension for these small endurance muscles.

Spend more time, 60-90 seconds, in the stretching ranges that are especially difficult or hard to stretch.

 

Doroski Chiropractic Neurology

3122 Golansky Blvd, Ste 102

Woodbridge VA 22192

703 730 9588

Map Link

Another working from injury!

in Chiropractor  by April 30, 2021 0 comments

Working from home sounded like such a great idea!  It is regarding the commute but the workstations people now use are creating lots of wrist and hand pain.  Carpal tunnel is the most common wrist complaint I see as your Woodbridge, Dale City VA Chiropractor.  Here is some information that will help you avoid this type of injury.

CTS typically occurs in adults, with women 3 times more likely to develop it than men. The dominant hand is usually affected first, and the pain is typically severe. CTS is especially common in assembly-line workers in manufacturing, sewing, finishing, cleaning, meatpacking, and similar industries. Contrary to the conventional wisdom, according to recent research, people who perform data entry at a computer (up to 7 hours a day) are not at increased risk of developing CTS.

What Is CTS?

CTS is a problem of the median nerve, which runs from the forearm into the hand. CTS occurs when the median nerve gets compressed in the carpal tunnel—a narrow tunnel at the wrist—made up of bones and soft tissues, such as nerves, tendons, ligaments, and blood vessels. The compression may result in pain, weakness, and/or numbness in the hand and wrist, which radiates up into the forearm. CTS is the most common of the “entrapment neuropathies”—compression or trauma of the body’s nerves in the hands or feet.

What Are the Symptoms?

Burning, tingling, itching, and/or numbness in the palm of the hand and thumb, index, and middle fingers are most common. Some people with CTS say that their fingers feel useless and swollen, even though little or no swelling is apparent. Since many people sleep with flexed wrists, the symptoms often first appear while sleeping. As symptoms worsen, they may feel tingling during the day. In addition, weakened grip strength may make it difficult to form a fist or grasp small objects. Some people develop wasting of the muscles at the base of the thumb. Some are unable to distinguish hot from cold by touch.

Why Does CTS Develop?

Some people have smaller carpal tunnels than others, which makes the median nerve compression more likely. In others, CTS can develop because of an injury to the wrist that causes swelling, over-activity 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.

How Is It Diagnosed?

CTS should be diagnosed and treated early. A standard physical examination of the hands, arms, shoulders, and neck can help determine if your symptoms are related to daily activities or to an underlying disorder.

Your doctor of chiropractic can use other specific tests to try to produce the symptoms of carpal tunnel syndrome.  The most common are:

Pressure-provocative test. A cuff placed at the front of the carpal tunnel is inflated, followed by direct pressure on the median nerve.

Carpal compression test. Moderate pressure is applied with both thumbs directly on the carpal tunnel and underlying median nerve at the transverse carpal ligament. The test is relatively new.

Laboratory tests and x-rays can reveal diabetes, arthritis, fractures, and other common causes of wrist and hand pain. Sometimes electrodiagnostic tests, such as nerveconduction velocity testing, are used to help confirm the diagnosis. 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 and will point your doctor of chiropractic to this diagnosis.

What Is the CTS Treatment?

Initial therapy includes:

Resting the affected hand and wrist

Avoiding activities that may worsen symptoms

Immobilizing the wrist in a splint to avoid further damage from twisting or bending

Applying cool packs to help reduce swelling from inflammations

Some medications can help with pain control and inflammation. Studies have shown that vitamin B6 supplements may relieve CTS symptoms.

Chiropractic joint manipulation and mobilization of the wrist and hand, stretching and strengthening exercises, soft-tissue mobilization techniques, and even yoga can be helpful. Scientists are also investigating other therapies, such as acupuncture, that may help prevent and treat this disorder.

Occasionally, patients whose symptoms fail to respond to conservative care may require surgery. The surgeon releases the ligament covering the carpal tunnel. The majority of patients recover completely after treatment, and the recurrence rate is low. Proper posture and movement as instructed by your doctor of chiropractic can help prevent CTS recurrences.

How Can CTS Be Prevented?

The American Chiropractic Association recommends the following tips:

Perform on-the-job conditioning, such as stretching and light exercises.

Take frequent rest breaks.

Wear splints to help keep the wrists straight.

Use fingerless gloves to help keep the hands warm and flexible.

Use correct posture and wrist position.

To minimize workplace injuries, jobs can be rotated among workers. Employers can also develop programs in ergonomics—the process of adapting workplace conditions and job demands to workers’ physical capabilities.

 

Doroski Chiropractic Neurology

3122 Golansky Blvd, Ste 102

Woodbridge VA 22192

703 730 9588

Map Link

The new work from home injury!

in Chiropractor  by May 22, 2020 0 comments

Carpal tunnel is a problem with a perfect work station.  Now let’s deal with everyone working from home, kitchen table, couch, coffee table…  As your chiropractor in the Woodbridge, Dale City VA area I have seen more of this complaint since we have been on lock down.  This information can help you prevent the injury.

The forearm and digit energizer series is a great way to manage that fatigue and pain you are feeling creep into your hands and wrists from excessive typing, gripping, or handstand walking.

This series is challenging and can place your hands into a position that they may not be comfortable being in to start, so exercise restraint on your first time. If you find your hands, wrists, or fingers are tender in any of these stretches, try first to reduce the pressure applied, and then slowly and progressively increase that pressure over time until you gain a full range of motion. We encourage you to challenge yourself with the finger flexing and neuromuscular components shown as well. You will be surprised at how much dexterity you gain from just a few round of this series, and the fatigue you feel when you first begin is expected. However, in time, when your fingers are dancing across your keyboard pain free and you suddenly are able to shuffle a deck of cards like a riverboat gambler, you will understand why we call it the energizer series!

A couple things to remember:

Complete 5-10 good reps of all the exercises shown, and take the time to slow down the movement and get a good amount of time under tension for these small endurance muscles.

Spend more time, 60-90 seconds, in the stretching ranges that are especially difficult or hard to stretch.

 

Doroski Chiropractic Neurology

3122 Golansky Blvd, Ste 102

Woodbridge VA 22192

703 730 9588

Map Link

Carpal Tunnel Injury

in Chiropractor  by April 10, 2020 0 comments

This blog is for all of you who have turned their kitchen table into a workstation for the time being.  Or the ones rolled into a couch with a laptop.  Either way be careful of those wrist angles and long periods of use.  Your Woodbridge, Dale City VA Chiropractor has some information on the most common wrist injury.

CTS typically occurs in adults, with women 3 times more likely to develop it than men. The dominant hand is usually affected first, and the pain is typically severe. CTS is especially common in assembly-line workers in manufacturing, sewing, finishing, cleaning, meatpacking, and similar industries. Contrary to the conventional wisdom, according to recent research, people who perform data entry at a computer (up to 7 hours a day) are not at increased risk of developing CTS.

What Is CTS?

CTS is a problem of the median nerve, which runs from the forearm into the hand. CTS occurs when the median nerve gets compressed in the carpal tunnel—a narrow tunnel at the wrist—made up of bones and soft tissues, such as nerves, tendons, ligaments, and blood vessels. The compression may result in pain, weakness, and/or numbness in the hand and wrist, which radiates up into the forearm. CTS is the most common of the “entrapment neuropathies”—compression or trauma of the body’s nerves in the hands or feet.

What Are the Symptoms?

Burning, tingling, itching, and/or numbness in the palm of the hand and thumb, index, and middle fingers are most common. Some people with CTS say that their fingers feel useless and swollen, even though little or no swelling is apparent. Since many people sleep with flexed wrists, the symptoms often first appear while sleeping. As symptoms worsen, they may feel tingling during the day. In addition, weakened grip strength may make it difficult to form a fist or grasp small objects. Some people develop wasting of the muscles at the base of the thumb. Some are unable to distinguish hot from cold by touch.

Why Does CTS Develop?

Some people have smaller carpal tunnels than others, which makes the median nerve compression more likely. In others, CTS can develop because of an injury to the wrist that causes swelling, over-activity 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.

How Is It Diagnosed?

CTS should be diagnosed and treated early. A standard physical examination of the hands, arms, shoulders, and neck can help determine if your symptoms are related to daily activities or to an underlying disorder.

Your doctor of chiropractic can use other specific tests to try to produce the symptoms of carpal tunnel syndrome.  The most common are:

Pressure-provocative test. A cuff placed at the front of the carpal tunnel is inflated, followed by direct pressure on the median nerve.

Carpal compression test. Moderate pressure is applied with both thumbs directly on the carpal tunnel and underlying median nerve at the transverse carpal ligament. The test is relatively new.

Laboratory tests and x-rays can reveal diabetes, arthritis, fractures, and other common causes of wrist and hand pain. Sometimes electrodiagnostic tests, such as nerveconduction velocity testing, are used to help confirm the diagnosis. 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 and will point your doctor of chiropractic to this diagnosis.

What Is the CTS Treatment?

Initial therapy includes:

Resting the affected hand and wrist

Avoiding activities that may worsen symptoms

Immobilizing the wrist in a splint to avoid further damage from twisting or bending

Applying cool packs to help reduce swelling from inflammations

Some medications can help with pain control and inflammation. Studies have shown that vitamin B6 supplements may relieve CTS symptoms.

Chiropractic joint manipulation and mobilization of the wrist and hand, stretching and strengthening exercises, soft-tissue mobilization techniques, and even yoga can be helpful. Scientists are also investigating other therapies, such as acupuncture, that may help prevent and treat this disorder.

Occasionally, patients whose symptoms fail to respond to conservative care may require surgery. The surgeon releases the ligament covering the carpal tunnel. The majority of patients recover completely after treatment, and the recurrence rate is low. Proper posture and movement as instructed by your doctor of chiropractic can help prevent CTS recurrences.

How Can CTS Be Prevented?

The American Chiropractic Association recommends the following tips:

Perform on-the-job conditioning, such as stretching and light exercises.

Take frequent rest breaks.

Wear splints to help keep the wrists straight.

Use fingerless gloves to help keep the hands warm and flexible.

Use correct posture and wrist position.

To minimize workplace injuries, jobs can be rotated among workers. Employers can also develop programs in ergonomics—the process of adapting workplace conditions and job demands to workers’ physical capabilities.

 

Doroski Chiropractic Neurology

3122 Golansky Blvd, Ste 102

Woodbridge VA 22192

703 730 9588

Map Link

Carpal Tunnel Stretch

in Chiropractor  by May 10, 2019 0 comments

To go along with a previous post about carpal tunnel here is a very helpful stretch.  Carpal tunnel injuries have become one of the biggest work-related injuries worldwide.  It is also one of the most common work-related surgeries performed.  Your chiropractor in the Woodbridge, Dale City VA area would like to help you avoid this injury.

The forearm and digit energizer series is a great way to manage that fatigue and pain you are feeling creep into your hands and wrists from excessive typing, gripping, or handstand walking.

This series is challenging and can place your hands into a position that they may not be comfortable being in to start, so exercise restraint on your first time. If you find your hands, wrists, or fingers are tender in any of these stretches, try first to reduce the pressure applied, and then slowly and progressively increase that pressure over time until you gain a full range of motion. We encourage you to challenge yourself with the finger flexing and neuromuscular components shown as well. You will be surprised at how much dexterity you gain from just a few round of this series, and the fatigue you feel when you first begin is expected. However, in time, when your fingers are dancing across your keyboard pain free and you suddenly are able to shuffle a deck of cards like a riverboat gambler, you will understand why we call it the energizer series!

A couple things to remember:

Complete 5-10 good reps of all the exercises shown, and take the time to slow down the movement and get a good amount of time under tension for these small endurance muscles.

Spend more time, 60-90 seconds, in the stretching ranges that are especially difficult or hard to stretch.

 

Doroski Chiropractic Neurology

3122 Golansky Blvd, Ste 102

Woodbridge VA 22192

703 730 9588

Map Link

Carpal Tunnel Injury

in Chiropractor  by April 5, 2019 0 comments

Wrist pain is more and more common these days.  Computer work is one of the biggest causes and that includes video games.  As your chiropractor in the Woodbridge, Dale City VA area I see lots of carpal tunnel complaints

CTS typically occurs in adults, with women 3 times more likely to develop it than men. The dominant hand is usually affected first, and the pain is typically severe. CTS is especially common in assembly-line workers in manufacturing, sewing, finishing, cleaning, meatpacking, and similar industries. Contrary to the conventional wisdom, according to recent research, people who perform data entry at a computer (up to 7 hours a day) are not at increased risk of developing CTS.

What Is CTS?

CTS is a problem of the median nerve, which runs from the forearm into the hand. CTS occurs when the median nerve gets compressed in the carpal tunnel—a narrow tunnel at the wrist—made up of bones and soft tissues, such as nerves, tendons, ligaments, and blood vessels. The compression may result in pain, weakness, and/or numbness in the hand and wrist, which radiates up into the forearm. CTS is the most common of the “entrapment neuropathies”—compression or trauma of the body’s nerves in the hands or feet.

What Are the Symptoms?

Burning, tingling, itching, and/or numbness in the palm of the hand and thumb, index, and middle fingers are most common. Some people with CTS say that their fingers feel useless and swollen, even though little or no swelling is apparent. Since many people sleep with flexed wrists, the symptoms often first appear while sleeping. As symptoms worsen, they may feel tingling during the day. In addition, weakened grip strength may make it difficult to form a fist or grasp small objects. Some people develop wasting of the muscles at the base of the thumb. Some are unable to distinguish hot from cold by touch.

Why Does CTS Develop?

Some people have smaller carpal tunnels than others, which makes the median nerve compression more likely. In others, CTS can develop because of an injury to the wrist that causes swelling, over-activity 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.

How Is It Diagnosed?

CTS should be diagnosed and treated early. A standard physical examination of the hands, arms, shoulders, and neck can help determine if your symptoms are related to daily activities or to an underlying disorder.

Your doctor of chiropractic can use other specific tests to try to produce the symptoms of carpal tunnel syndrome.  The most common are:

Pressure-provocative test. A cuff placed at the front of the carpal tunnel is inflated, followed by direct pressure on the median nerve.

Carpal compression test. Moderate pressure is applied with both thumbs directly on the carpal tunnel and underlying median nerve at the transverse carpal ligament. The test is relatively new.

Laboratory tests and x-rays can reveal diabetes, arthritis, fractures, and other common causes of wrist and hand pain. Sometimes electrodiagnostic tests, such as nerveconduction velocity testing, are used to help confirm the diagnosis. 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 and will point your doctor of chiropractic to this diagnosis.

What Is the CTS Treatment?

Initial therapy includes:

Resting the affected hand and wrist

Avoiding activities that may worsen symptoms

Immobilizing the wrist in a splint to avoid further damage from twisting or bending

Applying cool packs to help reduce swelling from inflammations

Some medications can help with pain control and inflammation. Studies have shown that vitamin B6 supplements may relieve CTS symptoms.

Chiropractic joint manipulation and mobilization of the wrist and hand, stretching and strengthening exercises, soft-tissue mobilization techniques, and even yoga can be helpful. Scientists are also investigating other therapies, such as acupuncture, that may help prevent and treat this disorder.

Occasionally, patients whose symptoms fail to respond to conservative care may require surgery. The surgeon releases the ligament covering the carpal tunnel. The majority of patients recover completely after treatment, and the recurrence rate is low. Proper posture and movement as instructed by your doctor of chiropractic can help prevent CTS recurrences.

How Can CTS Be Prevented?

The American Chiropractic Association recommends the following tips:

Perform on-the-job conditioning, such as stretching and light exercises.

Take frequent rest breaks.

Wear splints to help keep the wrists straight.

Use fingerless gloves to help keep the hands warm and flexible.

Use correct posture and wrist position.

To minimize workplace injuries, jobs can be rotated among workers. Employers can also develop programs in ergonomics—the process of adapting workplace conditions and job demands to workers’ physical capabilities.

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Doroski Chiropractic Neurology

3122 Golansky Blvd, Ste 102

Woodbridge VA 22192

703 730 9588

Map Link

Carpal Tunnel Prevention

in Chiropractor  by June 1, 2018 0 comments

Carpal tunnel syndrome can be very problematic especially now that everything we do seems to involve a keyboard of some sort.  This used to be an injury seen mainly in people who type all day.  Now everything we do no matter what your job seems to involve typing or keyboard use.  Complete side note my mom got it from knitting.  As your chiropractor in the Woodbridge, Dale City VA area I want to show you a stretch that can help.

The forearm and digit energizer series is a great way to manage that fatigue and pain you are feeling creep into your hands and wrists from excessive typing, gripping, or handstand walking.

This series is challenging and can place your hands into a position that they may not be comfortable being in to start, so exercise restraint on your first time. If you find your hands, wrists, or fingers are tender in any of these stretches, try first to reduce the pressure applied, and then slowly and progressively increase that pressure over time until you gain a full range of motion. We encourage you to challenge yourself with the finger flexing and neuromuscular components shown as well. You will be surprised at how much dexterity you gain from just a few round of this series, and the fatigue you feel when you first begin is expected. However, in time, when your fingers are dancing across your keyboard pain free and you suddenly are able to shuffle a deck of cards like a riverboat gambler, you will understand why we call it the energizer series!

LINK TO STRETCHES

A couple things to remember:

Complete 5-10 good reps of all the exercises shown, and take the time to slow down the movement and get a good amount of time under tension for these small endurance muscles.

Spend more time, 60-90 seconds, in the stretching ranges that are especially difficult or hard to stretch.

+scottdoroski3122/posts

+doroskichiropractic3122/posts

 

Doroski Chiropractic Neurology

3122 Golansky Blvd, Ste 102

Woodbridge VA 22192

703 730 9588

Map Link

Wrist stretching

in Chiropractor  by May 10, 2017 0 comments

With the increased use of computer keyboards, video games  and other computer devices wrist and carpal tunnel injuries have increased worldwide.  I have to say in my Woodbridge, Dale City VA Chiropractic office I have also seen a spike in carpal tunnel complaints.  It is very important to take breaks and stretch your wrists and forearms to avoid a bigger problem.

The forearm and digit energizer series is a great way to manage that fatigue and pain you are feeling creep into your hands and wrists from excessive typing, gripping, or handstand walking.

This series is challenging and can place your hands into a position that they may not be comfortable being in to start, so exercise restraint on your first time. If you find your hands, wrists, or fingers are tender in any of these stretches, try first to reduce the pressure applied, and then slowly and progressively increase that pressure over time until you gain a full range of motion. We encourage you to challenge yourself with the finger flexing and neuromuscular components shown as well. You will be surprised at how much dexterity you gain from just a few round of this series, and the fatigue you feel when you first begin is expected. However, in time, when your fingers are dancing across your keyboard pain free and you suddenly are able to shuffle a deck of cards like a riverboat gambler, you will understand why we call it the energizer series!

A couple things to remember:

Complete 5-10 good reps of all the exercises shown, and take the time to slow down the movement and get a good amount of time under tension for these small endurance muscles.

Spend more time, 60-90 seconds, in the stretching ranges that are especially difficult or hard to stretch.

+scottdoroski3122/posts

+doroskichiropractic3122/posts

 

Doroski Chiropractic Neurology

3122 Golansky Blvd, Ste 102

Woodbridge VA 22192

703 730 9588

Map Link

Carpal Tunnel

in Chiropractor  by February 6, 2015 0 comments

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.

Symptoms

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.

Diagnosis

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.

Treatment

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.

Reference

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.

Workplace Ergonomics

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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Doroski Chiropractic Neurology

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Woodbridge VA 22192

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