Carpal Tunnel Syndrome : Chiropractic Biophysics Patient Resources

Figure 1. X-ray of the hand and the wrist showing the ‘carpal bones’ or wrist bones. Carpal tunnel syndrome affects the thumb and 1^st two fingers of the hand.

What is Carpal Tunnel Syndrome (CTS)?

Carpal Tunnel Syndrome is the effects of pressure on the median nerve as it passes through the wrist into the hand. It most likely occurs with inflammation of the 9 wrist flexor tendons that pass through the carpal tunnel (8 carpal bones on the back of the hand and the carpal ligament on the front side) with the median nerve. See Figure 1.

Who does it affect?

Carpal Tunnel Syndrome or CTS rarely affects children. CTS is more common in:

· Adults who perform repetitive work involving use of the wrist flexors; curling the hand upwards toward the forearm,

· Adults with metabolic syndromes like diabetes are at higher risk,

· Women (5.8% of women) than in men (0.6% of men).

What are the symptoms and signs of Carpal Tunnel Syndrome (CTS)?

There are a number of symptoms associated with CTS; these include:

· Numbness in the hand with localization into the first 2 fingers and thumb as in Figure 1,

· Burning in the thumb, pointer and middle finger of the involved hand as in Figure 1,

· Weakness in the hand and loss of grip strength,

· Loss of dexterity and radiation of symptoms up the forearm may occur.

Chiropractic examination procedures to investigate possible causes of CTS:

Your doctor of chiropractic will most likely employ a variety of examination procedures to assist in the identification of possible causes of CTS:

· A history of your condition,

· Postural and biomechanical analysis (See Figure 2),

· Diet and exercise evaluation,

· Orthopedic and neurologic tests,

· Radiographs or X-rays of the neck (See Figure 3),

· Your Chiropractor may also send ask for further evaluation such as high-resolution ultra-sonography for cross sectional area (CSA) or nerve conduction study (NCS).

· It is important to rule out double crush syndromes (nerve compression in more than one are. For example: in addition to wrist pressure other areas such as the neck, shoulder, and elbow can put pressure on the nerves.) This would make CTS a part of a more significant problem.

Figure 2. Abnormal posture can contribute to the cause of Carpal Tunnel Symptoms. Here the ear is very far in front of the shoulder; this is termed forward or anterior head posture. When the head is this far forward, the nerves in the neck can be stretched. Importantly, the neck nerves travel down into the arm and hand and when neck nerves are irritated you may feel symptoms in the hand that mimic carpal tunnel.

Also, forward head posture causes the neck muscles to contract and this contraction can place increased pressure on the nerves going down into the arm and hand.

Figure 3. Shown in A, is the human spinal column from the side showing you perspective for where the neck or cervical spine is located. In B, a large view of an x-ray of the normal curvature of the neck from the side view is shown. The white circle around the man’s neck shows you what part of the spine you are looking at. The Person is looking to the readers left. This normal curvature is called a Cervical Lordosis. There is a red circular arc along the neck bones showing the normal curvature of the cervical lordosis (neck curve) from the side.

Shown in C, is an abnormal cervical curvature. Abnormal cervical curvatures can contribute to the cause of Carpal Tunnel Symptoms. The nerves in the neck can be stretched and irritated from loss of the cervical curve. Importantly, the neck nerves travel down into the arm and hand and when neck nerves are irritated you may feel symptoms in the hand that mimic carpal tunnel. Only spinal x-rays can show a Chiropractor what the state of your neck curve is.

Treatment Procedures that DC's commonly use

Chiropractic management is focused on restoring normal movement and alignment of the spine and upper extremities with joint manipulation, traction and exercises. See Figure 3 for normal vs. abnormal alignment. Braces, stretches, cryotherapy (ice_, ergonomic education, and nutritional advice may also be utilized as chiropractors typically treat with a holistic approach.

Common Medical Interventions

After conservative treatments such as bracing and resting are tried, common medical treatments typically involve anti-inflammatory drugs and then operative release of the transverse carpal ligament. Due to the common adverse risks associated with anti-inflammatory drugs (stomach bleeding, kidney damage, premature death, etc…)¹ and the invasiveness of the surgery, it is our opinion that Chiropractic treatments should be attempted initially for those patients with spinal and joint involvement.

Chiropractic Care May Have a Positive Influence on Carpal Tunnel Syndrome (CTS)

Chiropractic adjustments and rehabilitation procedures offer a safe and effective means of an initial course of treatment for patients suffering from Carpal Tunnel Syndrome. Several research studies and review articles have shown the potential benefits of chiropractic care for improving Carpal Tunnel Syndrome. These studies range from randomized trials to case reports.^2-11 Significantly, Chiropractic BioPhysics^®(CBP^®) Technique care has promising ability to improve patients suffering from signs and symptoms of CTS.^9,10

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References

1. Moore TJ, Cohen MR, Furberg CD. Serious adverse drug events reported to the food and drub administration; 1998-2005. Archives Internal Med 2007;167(16):1752-1759.

2. Bonebrake, Alan R DC; Fernandez, Jeffrey E Ph.D; Marley, Robert J Ph.D; Dahalan, Jalaluddin B; Kilmer, Kevin J. A Treatment For Carpal Tunnel Syndrome: Evaluation Of Objective And Subjective Measures. Journal Of Manipulative And Physiologic Therapeutics 1990; 13:507-520.

3. Bonebrake, Alan R DC; Fernandez, Jeffrey E, PhD; Dahalan, Jalaluddin B, DC; Marley, Robertj, PhD. A Treatment For Carpl Tunnel Syndrome: Results Of A Follow-Up Study. Journal Of Manipulative And Physiologic Therapeutics 1993; 16:125-139.

4. Burke, Jeanmarie PhD; Buchberger, Dale J DC PT; Carey-Loghmani, M Terry PT; Dougherty, Paul E DC; Greco, Douglas S DC; Dishman, J Donald DC. A Pilot Study Comparing Two Manual Therapy Interventions For Carpal Tunnel Syndrome. Journal Of Manipulative And Physiologic Therapeutics 2007; 30:50-61.

5. Davis, Ardee F DC. A Functional Approach To Median Nerve Entrapment:: A Case Report.. Journal Of The American Chiropractic Association 2004; 41:32-38.

6. Ferezy, Joseph S DC; Norlin, William, T. Carpal Tunnel Syndrome: A Case Report. Chiropractic Technique 1989; :19-22.

7. George, James W DC; Tepe, Rodger, Ph.D.; Busold, Damien, D.C.; Keuss, Sarah, D.C.; Skaggs, Clayton, D.C.. The Effects Of Active Release Technique On Carpal Tunnel Patients: A Pilot Study. Journal Of Chiropractic Education 2006; 20:14-15.

8. Mariano, Kurt A DC. Double Crush Syndrome: Chiropractic Care Of An Entrapment Neuropathy. Journal Of Manipulative And Physiologic Therapeutics 1991; 14:262-265.

9. Valente, Richard. Chiropractic Therapy In Carpal Tunnel Syndrome: A Case Study. Aca Journal Of Chiropractic 1991; 28:76-78.

10. Pope, Michael DC. Chiropractic: The Physics Of Spinal Correction. CBP® technique: Chapter 12: Applied Chiropractic Biophysics: Case #41. 1994; :10-12.

11. Pope, Michael DC. Chiropractic: The Physics Of Spinal Correction. CBP® technique: Chapter 12: Applied Chiropractic Biophysics: Case #421. 1994; :52-54.

Disclaimer

The primary purpose of this list of and general discussion of health conditions is to inform the public of the possibility that use of Chiropractic care may be associated with positive improvements in a variety of health conditions for patients actively undergoing Chiropractic care. Many of these symptoms require co-management and/or referrals to other health care specialists. This information is not intended, nor should it be used, to diagnose or treat any individual’s unique health condition.

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