Carpal Tunnel Syndrome

What is carpal tunnel syndrome? It is a common condition where the median nerve that receives sensation from the thumb, index and the middle finger of the hand is irritated.  The median nerve runs through a tight space between a fibrous band of connective tissue and the wrist bone, which is called the carpal tunnel.

Any condition that causes swelling or a change in position of the wrist bone within the carpal tunnel can squeeze and irritate the median nerve. Irritation of the median nerve in this manner causes tingling and numbness of the thumb, index, and the middle fingers, a condition known as "carpal tunnel syndrome."

What conditions and diseases cause carpal tunnel syndrome?

For most patients, the cause of their carpal tunnel syndrome is unknown. Any condition that exerts pressure on the median nerve at the wrist can cause carpal tunnel syndrome. Common conditions that can lead to carpal tunnel syndrome include obesity, pregnancy, hypothyroidism, arthritis, diabetes, trauma and repetitive use of the wrist.  Some rare diseases can cause deposition of abnormal substances in and around the carpal tunnel, leading to nerve irritation. 

How does a patient with carpal tunnel syndrome feel?

Patients with carpal tunnel syndrome initially feel numbness and tingling of the hand.  These sensations are often more pronounced at night and can awaken patients from sleep. Carpal tunnel syndrome may be a temporary condition that completely resolves with conservative care or it can persist and progress requiring invasive surgical procedures. As the disease progresses, patients can develop a burning sensation, cramping and weakness of the hand. Decreased grip strength can lead to frequent dropping of objects from the hand. Occasionally, sharp shooting pains can be felt in the forearm. Chronic carpal tunnel syndrome can also lead to wasting (atrophy) of the hand muscles, particularly those near the base of the thumb in the palm of the hand.

How is carpal tunnel syndrome diagnosed?

The diagnosis of carpal tunnel syndrome is suspected based on the symptoms and the distribution of the hand numbness. Examination of the neck, shoulder, elbow, pulses, and reflexes can be performed to exclude other conditions that can mimic carpal tunnel syndrome. The wrist can be examined for swelling, warmth, tenderness, deformity, and discoloration.  A nerve conduction velocity test may also be performed, which measures the rate of speed of electrical impulses as they travel down the nerve.

How is carpal tunnel syndrome treated?

The choice of treatment for carpal tunnel syndrome depends on the severity of the symptoms and any underlying disease that might be causing the symptoms. Initial treatment usually includes rest, light stretching of the wrist, immobilization of the wrist in a splint, and occasionally ice application. Patients whose occupations are aggravating the symptoms should modify their activities. For example, computer keyboards and chair height may need to be adjusted to optimize comfort. However, if the symptoms persist conservative care such as chiropractic treatment is recommended.  A chiropractic physician has extensive knowledge of the anatomy of the hand and wrist.  Chiropractic adjustment of the hand and wrist bones, which make up the carpal tunnel, can reestablish proper alignment of these joints.  In addition, massage of the muscles at the wrist and the use of ultrasound have been found to be very helpful.

One study involving 25 individuals diagnosed with carpal tunnel syndrome reported significant improvements in several measures of strength, range of motion, and pain after receiving chiropractic treatment. Most of these improvements were maintained for at least 6 months. 

There are other treatment options such as medication; non-steroidal anti-inflammatory drugs, corticosteroids, and surgery that have been helpful.  However, all these options hold a certain amount of risk and should be considered carefully.

Please contact our front desk to make an appointment with our staff chiropractor. / 503-655-0044