Carpal Tunnel Syndrome

Millions of people suffer from Carpal Tunnel Syndrome (CTS). (1) It is the great occupational disease of the 21st century. Do you have one or more of the following: tingling and numbness in hand, wrist and fingers, dry palms, intense pain (which can wake you at night), swelling in fingers, whitening of hand when you place pressure on it, or any similar symptoms in upper arm, elbow, neck or shoulder? (2>3)

An increasing number of those who suffer are now seeking chiropractic care for CTS. The drug-free relief that a chiropractic adjustment gives by releases nerve and spine stress by freeing your body of subluxations, has been a blessing to millions.

Where is the Carpal Tunnel? What is CTS?

It’s not on any map… The bones in your wrist (called carpals) form a tunnel-like structure. Thus called the carpal tunnel, this is the area where nine tendons and the median nerve pass from the arm into the hand. When the median nerve becomes irritated, it is called CTS but you may
have also heard it called partial thenar atrophy, median neuritis, or occupational neuritis.

Everyone is susceptible to Carpal Tunnel Syndrome. It used to be that seamstresses, carpenters, telegraph operators, and meat cutters were the main occupations afflicted. Not true today – you’ll find office and computer workers, keyboardists, musicians and assembly line workers are the most prone to CTS. Other than occupational susceptibility, a fall on the hand, fractures, hand tools that are either poorly designed or vibrate can cause either CTS or damage to the palm of the hand. Diseases such as arthritis (rheumatoid or osteo), multiple myeloma, acromegaly, Paget’s disease or gout can also cause CTS. Often it can also be found in pregnant women, those with under active thyroid conditions and birth control users.

A similar condition, Thoracic Outlet Syndrome, is the irritation or compression of nerves in the brachial plexus. As the nerves exit the neck and enter the upper back into the arm, if they are pinched or irritated they can cause pain, numbness, weakness and tingling in the arm. (4) Researchers don’t agree on the cause, while some believe it is the hips and sacroiliac (lower spine) playing a large role still others claim it is an abnormal thoracic (mid-back) curve that causes the syndrome. (5)

Wrist immobilization, in other words – not using the wrist by wearing a splint or rest is the medical approach to CTS. Many people have used this method and found relief. Using drugs (anti-inflammatories or diuretics) or ice is other ways individuals have found to relieve CTS. (6>7) Corticosteriods are used for those with persistent symptoms. These are injected into the crease between the wrist and hand. Although they may provide relief, the relapse rate is high and the procedure has many side effects. With surgery, recovery may take 6 months to 10 years.8 Robert Mendelsohn, MD said of the limitations of standard medical care: "Since medical treatment for this condition is so often unsatisfactory, I have for years been recommending that my patients consult experts in muscle and joint therapy." (9)

It is curious that most people who do repetitive tasks actually do not get CTS. Thus, there must be a contributing factor to the condition. It may be the health of spine that is contributing and anyone suffering should see a chiropractor who will check to make sure the spine is aligned properly and free from nerve stress.

Observe the people who suffer or are susceptible to CTS. They use their neck and entire spine, not only wrists, to perform their daily tasks (10) such as playing the violin or typing out a report. Researchers and patients, for over 100 years, have been reporting success with treating CTS symptoms and overall body function through chiropractic adjustments. (11>13)

Many patients with carpal tunnel syndrome also have vertebral subluxations. (14) A subluxation is when the spine is misaligned and this causes irritation on the spinal nerve root. Compression on the nerves in the neck can actually cause a blockage in the flow of nutrients from the shoulder to the arm and make the areas more susceptible to injury (called double crush syndrome). (15>16) One study of 1,000 cases of CTS found, not surprisingly, that a great number of those also had arthritis in the neck. (17)

All those who suffer from carpal tunnel should see a chiropractor to make sure their spine is not under stress of subluxations. Not necessarily for treatment of carpal tunnel, but as a way of removing excess stress from the nervous system. It has made a difference for millions.

There are many diagnostic names which are used for upper extremity problems. Neuritis, bursitis, rotator cuff, frozen shoulder, tendonitis, sprain/strain, and carpal tunnel syndrome just to name a few. The brachial plexus is a mass of nerves which go from your neck to the shoulder and on down the arm, forearm, wrist and hand. These nerves allow your brain and upper extremity to communicate with each other. These nerves can become irritated at the spine, which is referred to as subluxation or a misalignment of the spinal bones causing irritation to the nerves; at the shoulder joint; in the forearm muscles; or at the wrist. Because of the vast and intricate way these nerves interrelate, headache; migraine; facial pain; painful and stiff neck and shoulder; and even lower back pain have been linked to the brachial plexus. Generally there is muscle pain in the neck, shoulder, arm, and even the hand and fingers, or a radiating pain in between any of these structures.

The chiropractic approach to shoulder, arm, wrist, and hand problems is well documented. [18>19] We analyze your nervous system using surface EMG technology to assess stress on the nervous system. Trigger points are another common cause of radiating shoulder and arm pain. Trigger points are usually chronic muscle contractions which cause the byproducts to pool and are unable to escape. This leads to its’ own nerve center which sends out constant nerve impulses and depending on where those nerve impulses travel, can cause the whole range of upper extremity conditions. Correction of these imbalances to your structure and nervous system along with specialized muscle work to release trigger points will allow your body to regain its’ ability to heal itself.

1 Atroshi I, Gummesson C, Johnsson R et al. Prevalence of carpal tunnel syndrome in a general population. JAMA, July 4, 1999, val. 282, No. 2 pp153-158
2 Davis L, Wellman H, Punnett L. Surveillance of work-related carpal tunnel syndrome in Massachusetts, 1992-1997: a report from the Massachusetts sentinel event notification system for occupational risks (SENSOR). Am J Ind Med. 2001;39(1):58-71.
3 Verghese J, Galanopoulou AS, Herskovitz S. Autonomic dysfunction in idiopathic carpal tunnel syndrome. Muscle Nerve. 2000;23(8):1209-1213.
4 Narakas AO. The role of thoracic outlet syndrome in the double crush syndrome. Annales de Chirurgie de la main et du Membre Superieur. 1990;9(5):331-340.
5 Liebenson CS. Thoracic outlet syndrome: diagnosis and conservative management. JMPT. 1988;1(6).
6 O’Gradaigh D, Merry P. Corticosteroid injection for the treatment of carpal tunnel syndrome. Ann Rheum Dis. 2000;59(11):918-919.
7 Pfeffer GB, Gelberman RH. The carpal tunnel syndrome. In NM Hadler (Ed.), Clinical Concepts in Regional Musculoskeletal Illness. Orlando, FL: Grune & Stratton, Inc., 1987;201-215.
8 Rietz KA, Onne L. Analysis of sixty-five operated cases of carpal tunnel syndrome. Acta Chir Scand. 1967;133:443-447.
9 Mendelsohn R. Treating Carpal Tunnel Syndrome. The People’s Doctor. 1982;8(9):7.
10 Ferezy J, Norlin W. Carpal tunnel syndrome: a case report. Chiropractic Technique. Jan/Feb 1989;19-22.
11 Bonebrake AR, et al. A treatment for carpal tunnel syndrome: evaluation of objective and subjective measures. JMPT. 1990;13:317-326.
12 Stoddard A. Manual of Osteopathic Practice (2nd Ed.) Melbourne, Australia: Hutchinson & Co., 1983:228.
13 Davis PT, Hulbert JR, Kassak KM, et al. Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trial. JMPT. 1998;21(5):317-326.
14 Upton ARM, McComas AJ. The double crush in nerve entrapment syndromes. Lancet. 1973;2L329.
15 Czaplak S. Impaired axoplasmic transport and the double crush syndrome: food for chiropractic thought. Clinical Chiropractic. Jan 1993;8-9.
16 Nemoto K et al. The double lesion neuropathy: an experimental study and clinical cases. Abstract 123, Second Int’l. Congress. Boston, MA, Oct. 1983.
17 Hurst LC, Weissburg D, Carroll RE. The relationship of the double crush syndrome (an analysis of 1,000 cases of carpal tunnel syndrome). J Hand Surg. 1985;10B:202.
18De Franca GG, Levine IJ. The T-4 Syndrome. JMPT 1995;18:34-37.
Polkingorn BS. Chiropractic Treatment of frozen shoulder syndrome (adhesive capsulitis) utilizing mechanical force, manually assisted short lever adjusting procedures. JMPT. 1995;18:105-115/
Ferguson LW. Treating shoulder dysfunction and “frozen shoulders.”   Chiropractic Technique. 1995;7:73-81
Sobel JS, Winters JC, Groenier K, Arendzen JH, Meyboom de Jong B. Comparison of physiotherapy, manipulation, and corticosteroid injection for treating shoulder complaints in general practice: randomized, single blind study.  British Medical Journal. 1997;314:1320-5.
Davis PT, Hulbert JR, Kassak KM, et al. Comparative efficacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trial. JMPT. 1998;21(5):317-326.
19 De Franca GG, Levine IJ. The T-4 Syndrome. JMPT. 1995;18:34-37.
Polkingorn BS. Chiropractic Treatment of frozen shoulder syndrome (adhesive capsulitis) utilizing mechanical force, manually assisted short lever adjusting procedures. JMPT. 1995;18:105-115/
Ferguson LW. Treating shoulder dysfunction and “frozen shoulders.”   Chiropractic Technique. 1995;7:73-81
Sobel JS, Winters JC, Groenier K, Arendzen JH, Meyboom de Jong B. Comparison of physiotherapy, manipulation, and corticosteroid injection for treating shoulder complaints in general practice: randomized, single blind study.  British Medical Journal. 1997;314:1320-5.
Davis PT, Hulbert JR, Kassak KM, et al. Comparative effeicacy of conservative medical and chiropractic treatments for carpal tunnel syndrome: a randomized clinical trial. JMPT. 1998;21(5):317-326.