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Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. It is characterized by pain, numbness or tingling felt in the wrist and hand (specifically the palmar side of the hand into the thumb and fingers-but not the little finger) or radiating pain up into the arm. The cause of this discomfort is irritation or damage to the median nerve. Along its course to the hand, the median nerve passes through a narrow and rigid tunnel (called the carpal tunnel) made of bone and ligament. Overuse of the wrist (as in sewing, playing piano, or repetitive work related activity) or injury to this tunnel may result in damage or irritation to the median nerve producing carpal tunnel syndrome. The median nerve may be compressed or entrapped anywhere along its path; you may be interested to know that there are 7 locations (in addition to the carpal tunnel) where the median nerve could be compressed. For this reason, it is important to establish the location of entrapment before treatment (especially if you are considering surgery).

How is carpal tunnel syndrome diagnosed?

In order to prevent permanent damage to the median nerve early diagnosis is essential. The first (and perhaps most important) step is a thorough history and physical exam of the neck, shoulder, forearm, wrist and hand. There are specific orthopedic and neurological tests that are effective in establishing a diagnosis. In order to confirm the diagnosis of CTS, a nerve conduction study may be performed.

What are the options for treating carpal tunnel syndrome?

Effectively treating carpal tunnel syndrome requires a multimodal approach. When at all possible, find a treatment plan that is minimally invasive without drugs or surgery. More invasive options should only be entertained after the conservative methods fail to produce the desired result. Our clinic offers an evidence based treatment strategy that consists of manual therapy and physiotherapy. Conservative methods that are not provided at LVC (but may be worth trying) are acupuncture and yoga. On the less conservative end of the spectrum, certain medications and local corticosteroid injections may be effective in reducing pain short term. The most invasive, last resort for pain resulting from carpal tunnel syndrome is surgery. Research your options carefully and discuss them with one of the chiropractors at LVC or your healthcare provider before making a decision.

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References

1. Bilecenoglu B, Uz A, Karalezli N. Possible anatomic structures causing entrapment neuropathies of the median nerve: an anatomic study. Acta Orthop Belg. 2005 Apr;71(2):169-76. Review.
2. Burke J, Buchberger DJ, Carey-Loghmani MT, Dougherty PE, Greco DS, Dishman JD. A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. J Manipulative Physiol Ther. 2007 Jan;30(1):50-61.
3. Brininger TL, Rogers JC, Holm MB, Baker NA, Li ZM, Goitz RJ. Efficacy of a fabricated customized splint and tendon and nerve gliding exercises for the treatment of carpal tunnel syndrome: a randomized controlled trial. Arch Phys Med Rehabil. 2007 Nov;88(11):1429-35.
4. Piazzini DB, Aprile I, Ferrara PE, Bertolini C, Tonali P, Maggi L, Rabini A, Piantelli S, Padua L. A systematic review of conservative treatment of carpal tunnel syndrome. Clin Rehabil. 2007 Apr;21(4):299-314. Review.
5. Napadow V, Liu J, Li M, Kettner N, Ryan A, Kwong KK, Hui KK, Audette JF. Somatosensory cortical plasticity in carpal tunnel syndrome treated by acupuncture. Hum Brain Mapp. 2007 Mar;28(3):159-71.