Carpal Tunnel: Hands-On!
Do you experience tingling or numbness in your hands and fingers? Maybe it feels like sharp pins and needles, or perhaps you experience burning feelings in your hands, wrists, and even forearms. Perhaps your symptoms are worse at night, or you wake up with numb hands in the morning.
Sometimes it is a minor annoyance that is, literally, shaken off –a brief flick or shake of the hands can help the sensations disappear or go away before continuing your daily routine.1
However, if left unaddressed and untreated, these symptoms may slowly progress and worsen to a point where holding a bagel causes sharp, shooting feelings into your fingers, or picking up and holding a stylus for a tablet is painfully frustrating. You may even experience a loss of grip strength or start dropping your phone or car keys more often.
Carpal tunnel syndrome often feels like numbness or uncomfortable sensations in your hands and wrists, particularly with your thumb, pointer, and middle fingers.1,2,3,4
But what is carpal tunnel syndrome?
What is the Carpal Tunnel, and How is it Injured?
Think of a mountain blocking the path of a train. Rather than spend additional time plotting a course to weave around the mountain, a tunnel is built for the train to move through it. That tunnel is the carpal tunnel; it consists of a series of small bones in the wrist in a U-shape, with a ligamentous band creating the “roof” of the mountain tunnel.
What train runs through the carpal tunnel? That would be the many ligaments, nerves, tendons, and vascular structures that supply mobility and strength to the hand. These structures run the length of the carpal tunnel and allow the wrist to engage in movements such as flexion, extension, and grip.
However, like other parts of the body, compromise and injury can occur in the tunnel area of the wrist. Inside the carpal tunnel is a specific nerve known as the median nerve, which supplies sensation to the palm side of the hand and the first 3 ½ fingers. Compression of the median nerve creates carpal tunnel syndrome symptoms. Carpal tunnel syndrome is the most common entrapment neuropathy of the upper extremity, hands, and wrists, affecting people who use their hands for a living. Carpal tunnel syndrome affects approximately 3% of the population! 2,4
(image from Google Images)
Symptoms of carpal tunnel syndrome can come on suddenly or gradually1,4, depending on the cause.
Acute injuries can damage or tear ligaments and tendons, fracture bones, create inflammation, cause swelling, and compress or pinch the nerve directly. Repetitive injuries, such as working an assembly line, grasping a steering wheel to drive, or typing on a keyboard, can cause injury to the wrist tendons. This causes swelling and other mechanical problems in the wrist, including carpal tunnel syndrome.4
Space-occupying tumors, using construction equipment and vibrational tools, and pregnancy8 can also contribute to the development of carpal tunnel syndrome.
Symptoms of Carpal Tunnel Syndrome
The probability of injury occurring to the wrist and median nerve is high because of our reliance on our hands to perform everyday activities. And it frequently affects both hands, although carpal tunnel syndrome is more common in your dominant hand.
Symptoms experienced during carpal tunnel syndrome1,3,4,5 include:
Hands feeling swollen and tight.
“Dead hand” sensation.
Tingling and numbness: Pressure on the median nerve creates tingling sensations and/or numbness that extend into the thumb, pointer, middle finger, and half of your ring finger of your affected hand. The pinky finger is rarely involved.
Sharp, burning, or dull achy pain along the palm and fingers.
Decreased feeling in the fingertips.
Electric-like shooting feelings in your wrist, fingers, and/or forearm.
Weakness of the hand muscles due to diminished blood flow and nerve impingement. The thumb’s pinching muscles are controlled by the median nerve.
Shoulder pain: Pain can radiate or travel up the arm and into the shoulder.
Nighttime or morning symptoms: Some patients report the pain is worst at night at bedtime or when first waking up in the morning.
Because many injuries of the wrist are from overuse or trauma6, carpal tunnel syndrome can occur with other associated conditions such as sprains, strains, muscle and ligament tears, contusions, wrist and hand fractures, tendinitis/tendinopathies, forearm injuries, and more.
Who is at risk for developing Carpal Tunnel Syndrome?
Carpal tunnel syndrome most often affects adults age 45-60, occurring two or three times more frequently in women than in men.7 The etiology of this condition is multifactorial; anatomic, systemic, and occupational factors have all been implicated.3
You could be at higher risk of developing carpal tunnel if you engage in the following activities or have one of these medical conditions:
Diabetes, hemodialysis, and thyroid conditions;
History of wrist fracture, deformity, or wrist dislocation;
Arthritic conditions;
Forceful, repetitive movement, e.g., construction and carpentry;
Excess or repeated stress on the wrist;
Sleeping ergonomics that result in the wrist being flexed or bent;
Sports and activities with repetitive hammering motions.
Additionally, pregnancy and the natural hormone fluctuations associated with proper fetal development may cause fluid retention, resulting in decreased space in the carpal tunnel for nerves and tendons to move.8
Is a chiropractor the right doctor for managing Carpal Tunnel Syndrome?
Proper treatment usually relieves the tingling and numbness and restores wrist and hand function.5 Addressing ergonomics and making changes to movement is an imperative part of an effective treatment plan. You may not be able to completely avoid the repetitive wrist strain, flexion, or postural stress that gave you carpal tunnel in the first place – especially if it's part of your job.
Surgery isn’t always necessary for treating carpal tunnel, either. Many options exist to address and treat carpal tunnel syndrome effectively and safely. Our doctors of chiropractic are experts at providing conservative care for many musculoskeletal conditions, including carpal tunnel syndrome. Treatment approaches may include specific stretches for muscles and tendons of the forearm and wrist, carpal bone mobilization4, nighttime splinting of the wrist6, nerve glide exercises4, and more.
Your treatment plan is unique to you and your condition, and we are trained to properly evaluate and treat most types of carpal tunnel syndrome. Don’t let pain dictate your life and alter your routine – give us a call and make your appointment today!
References
1. Wipperman, J., and Goerl, K. (2016). Carpal tunnel syndrome: Diagnosis and management. Am Fam Physician: 993-99.
2. Viera, A.J. (2003). Management of carpal tunnel syndrome. Am Fam Physician: 265-72.
3. Cranford, C.S., et al. (2007). Carpal tunnel syndrome. J Am Acad Orthop Surg: 537-48.
4. Souza, T.A. (2014). Differential Diagnosis and Management for the Chiropractor. Jones & Bartlett Publishers.
5. Mayo Clinic. (2020). “Carpal tunnel syndrome.” Retrieved February 2021 online from https://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/symptoms-causes/syc-20355603
6. Wilson, J.K., and Sevier, T.L. (2003). A review of treatment for carpal tunnel syndrome. Disabil Rehabil: 113-9.
7. Cleveland Clinic. (2019). “Carpal tunnel syndrome.” Retrieved February 2021 online from https://my.clevelandclinic.org/health/diseases/4005-carpal-tunnel-syndrome
8. Graeber, M.C., and Lucas, A.B. (2000). Management of pregnancy related carpal tunnel syndrome. J Miss State Med Assoc: 790-1.