Carpal Tunnel Syndrome
(and Double Crush Syndrome)
Repetitive Hand and Wrist Motion
Every day, assembly line workers, keyboard operators, grocery store clerks, and many others, receive microtraumas to their hands and wrists. Vibration and repetitive motions, when combined with spinal problems and other joint dysfunction, can result in a condition known as carpal tunnel syndrome.
How Chiropractic Care May Help
The major nerve controlling the thumb, index, and parts of the middle and ring finger is called the median nerve. From the tip of your fingers, it travels through the bones in your wrist, past your elbow, up your arm, through your shoulder and neck, and finally to your spinal cord. Problems can develop in one or more of these areas.
The carpal "tunnel" is formed by bones in the wrist. The median nerve, tendons, and blood vessels pass through this opening. If one or more of the bones forming this tunnel should collapse, inflammation, nerve pressure, and painful symptoms in the in the wrist area can result.
The median nerve connects to the spinal cord through openings between several bones in the lower neck. When these spinal bones lose their normal motion or position, they can cause problems in the fingers and wrist.
After a thorough examination, your chiropractic doctor will perform specific adjustments where needed to help normalize structure and reduce nerve irritation. When given time, conservative, chiropractic care has produced excellent results with carpal tunnel problems - without drugs or surgery.
Frequently Asked Questions about CTS
What is carpal tunnel syndrome?
Carpal tunnel syndrome (CTS) is a condition that affects the hands and wrists. The most common early symptoms of CTS are numbness, tingling and burning in the thumb, index and middle fingers - often at night or after manual work.
CTS occurs when a nerve that goes to the hand becomes compressed and inflamed as it passes through a space between the bones in the wrist called the "carpal tunnel."
CTS is commonly caused by repetitive hand movements, and the condition is often found in people who work at computers, grocery checkers, butchers, assembly line workers, and in other occupations requiring heavy use of the hands.
Can carpal tunnel syndrome be treated without surgery?
Yes. If detected early, CTS can be treated conservatively. Chiropractic is the leading method of non-surgical treatment of CTS.
How does a chiropractor treat carpal tunnel syndrome?
Chiropractic treatment for CTS may use a combination of:
1. Rest
2. Therapies, such as ice, ultrasound, and electrical stimulation.
3. Manipulation
4. Nutritional supplements
5. Electro-acupuncture
6. Use of a splint to prevent mechanical stress and to protect your wrist(s) during healing.
7. Special hand and wrist exercises
8. Removal of the cause: such as redesigning the work place to minimize stress, and avoiding repetitive motion of the wrists and hands.
Can I be tested for carpal tunnel syndrome?
Yes. Screening for carpal tunnel syndrome involves a brief history and physical examination. If CTS is suspected, a more thorough exam and additional tests may be recommended to obtain an accurate diagnosis and to rule out other conditions that mimic CTS.
If you are experiencing carpal tunnel syndrome or think you may be contact Dr. Vilkelis as soon as possible to schedule an appointment. Stop suffering today! You can contact Dr. Vilkelis by clicking here.
Double Crush Syndrome
The double crush syndrome is a compression neuropathy of two areas, one usually distant from the other. A growing number of researchers have suggested a correlation between some peripheral neuropathies, of which carpal tunnel syndrome is one and cervical nerve root compression another. The nerve is "crushed" or irritated in the spine, "priming" more distal areas of the nerve for dysfunction when that part is stressed (second "crush").
If you feel you fit this
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Peer Reviewed Publications:
Comparative efficacy of
conservative medical and chiropractic treatments for carpal tunnel syndrome: a
randomized clinical trial. Davis PT, Hulbert JR, Kassak KM, et al.
J Manipulative Physiol Ther. 1998 (Jun);21 (5): 317-326
- This study showed that chiropractic was as effective as medical treatment in reducing symptoms of CTS. Chiropractic care included spinal adjustments, ultrasound over the carpal tunnel, and the use of nighttime wrist supports. Carpal tunnel syndrome (CTS) can affect just about everyone, but particularly people involved in occupations requiring repetitive use of the hands and wrists (i.e., office and skilled labor jobs). Medical doctors commonly prescribe anti-inflammatory drugs, which prove ineffective in some patients and cause adverse side effects in others, for patients diagnosed with carpal tunnel syndrome.
Clinical commentary:
pathogenesis of cumulative trauma disorders. Mackinnon S.
J Hand Surg [Am]. 1994 (Sep);19 (5): 873-883
- Dr. Susan MacKinnon professor of surgery at Washington University School of Medicine in St. Louis in a study of 64 patients with repetitive stress disorders of whom 34 had wrist surgery it was discovered that wrist pain or discomfort was not the only symptom the patients complained of. Most patients had multiple problems, especially muscle imbalance. The high failure rate of surgery has caused her to rethink the cause of CTS: "Unnatural postures for extended periods creating pressure on the nerves in the neck, leading to neurological and other symptoms...even when extremity surgery improves the peripheral symptoms such as numbness in the hands, other associated problems like neck stiffness and shoulder pain persist," her article states.
A treatment for carpal
tunnel syndrome: evaluation of objective and subjective measures.
Bonebrake AR, Fernandez JE, Marley RJ et al.
J Manipulative Physiol Ther. 1990 (Nov-Dec);13 (9): 507-520
- Thirty eight CTS sufferers underwent spinal manipulation and extremity adjusting. In addition, soft tissue manipulation, dietary modifications or supplements and daily exercises were prescribed. Post treatment results showed improvement in all strength and range of motion measures. A significant reduction of nearly 15% in pain and distress ratings were documented.
Resolution of a
double-crush syndrome. Flatt DW.
J Manipulative Physiol Ther. 1994 (Jul-Aug);17 (6): 395-397
- A 63-year-old man suffered from a 36-month history of right anterior leg numbness and recurrent lower back pain. Complete resolution of right anterior leg numbness followed chiropractic treatment. Although not a carpal tunnel problem the double crush phenomenon, in this case involving the leg, and its resolution under chiropractic care is of interest.
The double crush in nerve
entrapment syndromes. Upton, ARM, McComas AJ.
Lancet. 1973 (Aug 18);2 (7825): 359-662
- 67% to 75% of patients studied who had carpal tunnel syndrome or ulnar neuropathy also had spine nerve root irritation.
Impaired axoplasmic transport and the double crush
syndrome: food for chiropractic thought. Czaplak S, Clinical
Chiropractic Jan. 1993 p.8-9.
- "Chiropractic has an extensive anecdotal history of patients being relieved of classic carpal tunnel symptoms with spinal adjustments and/or cervical tractioning only."
Carpal tunnel syndrome as an expression of muscular
dysfunction in the neck. Skubick DL, Clasby R, Donaldson CCS et al. J
Occup Rehabil 3:31-44, 1993.
- Carpal tunnel syndrome can occur from increased forearm flexor activity caused by muscle dysfunction in the neck. Study of 18 patients.
Comparison of
physiotherapy, manipulation, and corticosteroid injection for treating shoulder
complaints in general practice: randomized, single blind study. Sobel JS,
Winters JC, Groenier K, Arendzen JH, Meyboom de Jong B.
British Medical Journal 1997 (May 3);314 (7090): 1320-1325
- From the article: 198 patients with shoulder complaints were divided into two diagnostic groups: 58 in a shoulder girdle group and 114 into a synovial group. Patients in the shoulder girdle group were randomized to manipulation or physiotherapy and patients in the synovial group were randomized to corticosteroid injection, manipulation or physiotherapy. In the shoulder girdle group, the duration of complaints was significantly shorter after manipulation compared to physiotherapy. The number of patients reporting treatment failure was less with manipulation. In the synovial group duration of complaints was shortest after corticosteroid injection compared with manipulation and physiotherapy. (Note: either G.P.s or physiotherapists performed the manipulations).
Physical examination of the
cervical spine and shoulder girdle in patients with shoulder complaints.
Sobel JS, Winters JC, Groenier K, Arendzen JH, Meyboom de Jong B.
J Manipulative Physiol Ther. 1997 (May);20 (4): 257-262
- From the abstract: In the population of patients without shoulder complaints the mobility in the cervical and upper thoracic spine was found to decrease with aging.functional disorders in the cervical spine, the higher thoracic spine and the adjoining ribs are not extrinsic causes of shoulder complaints, but an integral part of the intrinsic causes of shoulder complaints.
The neuron and its response to peripheral nerve
compression. Dahlin LB, Lundborg G. J Hand Surg (Br Vol, 1990)
15B: 5-10.
The relationship of the
double crush syndrome (an analysis of 1,000 cases of carpal tunnel syndrome).
Hurst LC, Weissberg D, Carroll RE.
J Hand Surg [Br]. 1985 (Jun);10 (2): 202-204
- A significant correlation was found between bilateral carpal tunnel syndrome and radiologically diagnosed cervical arthritis.
Carpal tunnel syndrome in
100 patients: sensitivity, specificity of multi-neurophysiological procedures
and estimation of axonal loss of motor, sensory and sympathetic median nerve
fibers. Kuntzer T.
Journal of the Neurological Sciences 1994 (Dec 20);127 (2): 221-229
- In the patients studied, some degree of axonal loss for motor, sensory and sympathetic median nerve fibers was found in 42% of cases and 6 patients had a double-crush syndrome and 6 others had a concomitant ulnar neuropathy at the elbow.
Double crush syndrome:
chiropractic care of an entrapment neuropathy. Mariano KA; McDougle MA;
Tanksley GW.
J Manipulative Physiol Ther. 1991 (May);14 (4): 262-265
- Conservative management consisting of chiropractic manipulative therapy as well as ultrasound, electrical nerve stimulation, traction and a wrist splint is outlined. The experimental basis, clinical evidence, etiology, symptomatology and findings of this condition are discussed.
Thoracic outlet syndrome:
diagnosis and conservative management. Liebenson, CS
J Manipulative Physiol Ther. 1988 (Dec);11 (6): 493-499
-
Thoracic outlet syndrome is caused by compression or irritation of the
nerves as they exit the neck toward the upper extremity. Often it is the
compression or irritation of the brachial plexus, not from compression of
the subclavian artery. In this discussion, the author notes some researchers
who believe that the sacroiliac plays a large role in the etiology of this
condition. Others feel an abnormal thoracic curve is the cause.
The role of thoracic outlet
syndrome in the double crush syndrome. Narakas AO.
Ann Chir Main Memb Super. 1990;9 (5): 331-340
- The historical background and theoretical basis of the management of double crush syndrome is outlined and arguments for and against the association of the various neuropathies are presented.
Treating Shoulder Dysfunction and "Frozen Shoulders".
Ferguson LW. Chiropractic Technique, 1995; 7:73-81.
- Author's Abstract: This article presents three case histories to illustrate the treatment of "frozen shoulder" and related shoulder dysfunction as a combined disorder involving joint dysfunction and myofascial pain syndrome. The author reviews the literature and questions the traditional treatment approaches, which focus on treating inflammation and breaking adhesions. The concept of adhesive capsulitis as the only cause of "frozen shoulder" is challenged. The author proposes an alternative treatment protocol that addresses specific patterns of joint dysfunction and myofascial disorder.
- Comment: Dr. Ferguson utilized spinal adjustments and shoulder adjustments.