Carpal tunnel syndrome is a condition most people have heard of, but what is it exactly? Let our Oakville Chiropractor break it down for you.
Chiropractor: The Anatomy of the Carpal Tunnel
‘Carpal’ refers to the tiny bones that make up the wrist joint. There are 8 of those bones in total and they are arranged in an arched pattern. The carpal tunnel is a narrow passage between the arch of those bones and a fibrous bridge that covers them. The carpal tunnel serves as the entrance way from the forearm to the hand. The tendons of the forearm flexor muscles (9 tendons in total!) run through that tunnel, and so does the median nerve! More on carpel tunnel syndrome and treatment.
The forearm flexor muscles originate in the upper forearm and attach into the fingers and thumb to help curl the fingers. 3 different muscles have tendons that run through the carpal tunnel; the flexor digitorum profundus which is responsible for curling the last segment of the fingers (excluding the thumb), the flexor digitorum superficialis which curls the near segments of the fingers (excluding the thumb) and the flexor pollicis longus which flexes the thumb. If you were keeping count, that’s nine important tendons that run through a very narrow space.
The other important structure that runs through the carpal tunnel is the median nerve. Our hand is innervated by three different nerves (radial, ulnar and median). The median nerve innervates the skin on the palm of the hand and surface over the nailbeds of the 1st-3rd fingers (thumb, index and middle finger). The median nerve also innervates some of the deeper muscles between the fingers, and the muscle group that helps to move our thumb.
What Is Carpal Tunnel Syndrome?
The borders of the carpal tunnel are all very rigid. The bones are strong and linked together by a network of ligaments. The roof of the carpal tunnel is made of a thick, fibrous tissue that also doesn’t have a lot of ‘give’. With the nine tendons and one nerve travelling through a narrow passageway, it can be a tight squeeze! Carpal tunnel results from the tunnel narrowing and/or the tendons causing a swelling that puts pressure on the nerve. If the median nerve gets compressed within the tunnel, it can cause carpal tunnel syndrome!
What Causes Carpal Tunnel Syndrome?
Carpal tunnel syndrome is not typically caused by an acute injury, but instead is caused by certain lifestyle factors and/or workplace factors.
There are certain occupations that have a higher risk of developing this condition. Any job that requires consistent use of the hands/fingers are more likely to develop carpal tunnel syndrome. Computer work, labourers, assembly line workers using fine motor skills, workers who use vibrating equipment or those whose work requires a strong grip are more at risk.
Obesity and pregnancy are also associated with carpal tunnel syndrome. Pregnant women experience a general fluid retention while pregnant (think of the swollen ankles and fingers pregnant women can get!). This fluid can also accumulate within the carpal tunnel and cause compression of the median nerve. While most women will experience complete recovery following the pregnancy, there area still a significant percentage of women who still experience symptoms post-partum that may require therapeutic intervention.
Symptoms of Carpal Tunnel Syndrome and How Your Chiropractor Can Help.
This condition typically comes on slowly, over a long period of time. There is no specific injury that is responsible for the onset of carpal tunnel. Instead, it appears gradually over a few months. The symptoms may come and go at first.
Numbness/Tingling in the Hand
The median nerve is responsible for sensation to the palm and skin over the nail beds. When the median nerve is compressed it can cause a loss of sensation, a feeling of tingling or even burning type pain in the hand.
In cases where the condition is severe and has been present for a long time, the muscles can waste away. In these cases, the muscles over the thumb can look smaller and cause a dimple in the palm.
As mentioned above, the median nerve innervates some of the muscles in the hand. Picking up heavier objects (ie – a pot of water), shaking hands and typing/mousing can all become difficult. The affected hand may feel clumsy.
In cases where the nerve is very irritated it can cause shock-like, sharp sensations into the wrist and hand. Activting the muscles that share the tunnel with the median nerve (by using the fingers) can cause sharp, painful zings.
The median nerve originates in the neck, travels through the middle of the arm and forearm before it enters the hand. Pain can be felt radiating upwards from the palm/wrist into the forearm and travelling up towards the shoulder.
Pain at night is a common occurrence with carpal tunnel syndrome. This is due to the fact that many people sleep with their hands and wrists curled inwards, causing further compression to the nerve and exacerbating the symptoms.
How Is Carpal Tunnel Syndrome Diagnosed By Our Oakville Chiropractor?
When you visit us at our Oakville chiropractic clinic, we will be able to diagnose your Carpal Tunnel Syndrome! Through a thorough history and physical exam our chiropractors will be able to determine if your pain is due to an issue within the carpal tunnel.
There are some simple tests that will help determine the correct diagnosis. Phalen’s test involves provoking/irritating the medial nerve to try and recreate the symptoms of carpal tunnel. Holding the wrists in this position compresses the median nerve, and is symptoms can be elicited by this test, you may have carpal tunnel syndrome. Tinel’s test is another test used for this condition. Taping a finger, or a reflex hammer, over the carpal tunnel and producing pain is considered a positive test for carpal tunnel syndrome. Our evidence-base chiropractors will use a number of other tests to rule out other conditions that may masquerade as Carpal Tunnel Syndrome.
In some cases, a nerve conduction study may be ordered by a medical doctor to help diagnose this condition. These tests will help determine the conductivity of the nerve, and be able to tell if there is any interference in the carpal tunnel that is impeding the function of the median nerve.
Carpal Tunnel Syndrome Treatment
Our Oakville chiropractor says that early intervention for carpal tunnel is extremely important. Conservative care is always recommended before more invasive methods, like surgery, are considered.
Stretching and mobilizing the contents of the carpal tunnel is one of the most important aspects of the rehabilitation process. Stretching the forearm muscles to try and decrease any irritation happening along the tendons in the carpal tunnel is crucial to decrease symptoms. There are simple exercises that can be used to mobilize the tendons within the carpal tunnel as well. These specific hand movements help glide the tendons back and forth within the tunnel with the goal of pumping out any inflammation within the tunnel that is contributing to the compression of the nerve. Inflammation can also be very ‘sticky’, and ensuring the tendons are gliding amongst each other as efficiently as possible is important in helping to reduce symptoms.
Lifestyle changes are another important factor in managing carpal tunnel syndrome. We use our hands a lot. These days, most of us spend a lot of time on our smart phones, computers or tablets. Many people spend 8 hours a day at the computer. Limiting the use the hands/fingers, and allowing the wrists breaks from occupational demands, is a mandatory part of recovery. An ergonomic assessment may reveal aspects of a job that are contributing the condition. Simple things, like wrist rests for a keyboard, may increase the compression of the median nerve and therefore worsen symptoms! This aspect of carpal tunnel syndrome is why the condition can be so difficult to treat. Making the appropriate changes to the daily routine will be difficult – but we guarantee they will help you get better more quickly!
Shockwave therapy is one of the favorite treating modalities for our Oakville Chiropractors when it comes to treating carpal tunnel. Follow the Oakville shockwave link for more information.
Our chiropractors also recommend wrist braces. These braces are designed to keep the wrist in a neutral position and therefore limit the compression of the nerve. The wrist braces can be worn during work to help avoid aggravation of the condition. Our chiropractors also recommend that you wear braces to bed to keep the wrists in neutral. Many of us sleep with our wrists and fingers curled inwards. This position compresses the median nerve, and will aggravate it for the 6-8 hours that you spend in bed every night. Keeping the wrist in a neutral position while you sleep will help eliminate the night pain often associated with this condition and let the body try and remove inflammation from the carpal tunnel overnight.
When choosing brace, we usually just direct our patients to Amazon. You want to choose a brace that has some rigidity, and does not allow the wrist to bend. You do not want a soft neoprene/sleeve brace; it needs to be a little bit more substantial. The brace doesn’t need to cost more than 20 dollars. Typically we see them range from 12-20!
As with any other condition that involves inflammation and irritation of tissues, we recommend regular icing. Any time the wrist feel painful, after computer work, following a workout or any time the hands/fingers have done a lot of work – ice the wrists! Icing will help to prevent inflammation from building up within the carpal tunnel and help to alleviate pain and discomfort.
Acupuncture For Carpal Tunnel in Oakville
One of the best conservative treatments for Carpal Tunnel Syndrome is acupuncture. Acupuncture is able to help remove inflammation from around the carpal tunnel and alleviate muscle tension within the flexor muscles that can contribute to pain and discomfort felt in the forearm.
Acupuncture for carpal tunnel involves stimulation of the median nerve at multiple points along its pathway. Unlike compression of the nerve, which causes irritation and pain, stimulation via acupuncture needles helps to remove irritating substances found in inflammation that aggravate the nerve. Dr. Jenn also uses acupuncture also helps to boost blood flow to the areas around the needles. This increase in blood flow helps to nourish muscles, helps alleviate tension and therefore helps decrease pain. More can be found about our Oakville Acupuncturist and what goes into an acupuncture visit here.