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Carpal Tunnel 1/08 Issue
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Thank You and Best Wishes for this New Year! |
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We have chosen talk about the topic of Carpal Tunnel for our January newsletter. The introduction gives a brief background on what Carpal Tunnel is and how the syndrome is formed. The carpal tunnel is located at the base of the hand. The tunnel is formed by the carpal bones and the transverse carpal ligament, also called the flexor retinaculum The tunnel contains the median nerve and nine tendons that travel through it. These tendons are surrounded by synovial sheaths, which protect them from friction when the wrist bends. Irritation and inflammation between the tendons and their sheaths (tenosynovitis) may cause pressure on the median nerve and produce the symptoms of CTS.
There are a number of other factors that may also cause CTS. For example, fluid retention during pregnancy has been known to cause CTS in women. This is sometimes referred to as gestational CTS. Certain metabolic factors or systemic diseases, such as diabetes or multiple sclerosis, may also contribute to this problem. | |
Acupuncture and Carpal Tunnel Syndrome
Will acupuncture help?
Acupuncture is often a successful treatment for carpal tunnel syndrome. It aims to decrease the local swelling and inflammation in the carpal tunnel itself, while relaxing the muscles of the forearm. There are several different acupuncture treatments for carpal tunnel syndrome, including local needling, the use of electrical stimulation, moxibustion and distal needling (or needling connected but distant parts of the body). The technique and treatment chosen by an acupuncturist depends on a persons€™s body type and related circumstances (ex. history of injury, arthritis, circulation, etc.).
Depending on the severity of the symptoms, a person typically receives biweekly acupuncture treatments and often notices an improvement in the first two weeks of treatment. Success with acupuncture depends greatly on a person’s ability to decrease or stop any repetitive motion that may exacerbate the condition while undergoing treatment. This allows the pressure on the median nerve to be eliminated without reintroducing it. Otherwise acupuncture will decrease the symptoms but not adequately treat the source. While individual circumstances influence the length of treatment, acupuncture does successfully treat mild to severe symptoms and has no negative or lingering side-effects.
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Chiropractic and Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS), is the most common of repetitive stress injuries (RSI), which annually cost in excess of $ 7 billion in workers' compensation, and $20 million in medical benefits, and lost wages. We commonly take for granted that our bodies can operate a computer mouse, type on a keyboard, or simply knit an afghan for prolonged periods of time until we experience pain. Previously, one of the common treatments for CTS was surgery, which proved beneficial in approximately half the cases. Chiropractic care are the only professionals which understand that the underlying problem must be found and corrected . If the cause is not found and treated unsuccessful treatment will result.
Other names for CTS
Occupational neuritis, partial thenar atrophy/ and median neuritis
Treatment: Chiropractic care by a chiropractor trained in the treatment of CTS is the most effective, least invasive and least costly of all the treatments . Chiropractic care gets to the cause of the problem and not just treating the effects. We know that if you don't correct the misalignment of the carpal bones thru chiropractic adjustments the cause is still there and the symptoms will return. We know that surgery causes the wrist to be structurally weakened when the ligaments are cut and cause the joint to developed arthritis. We know that the anti-inflammatory drugs and pain killers may help to relieve the pain and swelling but do nothing to reposition the carpal bones back into place. If the tunnel is not realigned the cause of the pressure on the median nerve is still there .
Exercises to strengthen the wrist and carpal tunnel Wrist extension and flexion exercise, I am not a big advocate of stretching exercises because the cause of CTS is an over stretching of the carpal ligament. I think after chiropractic treatment has corrected the problem then mild stretching may be useful to keep flexibility in the joints but not when there is pain numbness and tingling or any symptoms. Weighted wrist curls - I find one of the easiest exercises and most beneficial is wrist curls with a one to two pound weights. If you don't have weights you can use a can of vegetables from your pantry. The procedure is to hold the weight and then flex and extend your wrist slowly approximately 10-20 times three times per day .
If any of these exercises cause you problems consult your chiropractor immediately. Surgery - when surgery is performed the supporting ligament is cut and sometimes removed. This procedure relieves the pressure on the nerve but destroys the structural integrity of the joint in the wrist making them more prone to arthritis changes one study shows. Surgery should be the last resort, because a recent study show that 50% of the people having surgery within 18 months will need a second surgery. I have had several patients that have had three different surgeries on their CTS. Chiropractic care should be the first choice because it is non invasive and has excellent results. Concussion to the wrist is the most frequent cause of this problem. The trauma can be by a fall or it may be caused by or repetitive minor stress over a long period of time, is of particular significance when the trauma is falling on the hand, dorsiflexing the wrist, or using the hand in a wrist extended manner to force an object, such as striking a stuck window. Anyone who strains the wrist such as computer workers beauticians, waitresses, mechanics, carpenters & meat cutters are extra-susceptible to this condition.
Carpal tunnel syndrome (CTS), is the most common of repetitive stress injuries (RSI), which annually cost in excess of $ 7 billion in workers' compensation, and $20 million in medical benefits, and lost wages. We commonly take for granted that our bodies can operate a computer mouse, type on a keyboard, or simply knit an afghan for prolonged periods of time until we experience pain. Previously, one of the common treatments for CTS was surgery, which proved beneficial in approximately half the cases. Chiropractic care are the only professionals which understand that the underlying problem must be found and corrected . If the cause is not found and treated unsuccessful treatment will result. |
Massage Therapy and Carpal Tunnel Syndrome
The most common symptoms of CTS include pain, numbness or paresthesia in the median-nerve distribution of the hand. Symptoms are often worse at night due to the tendency of people to bend their wrists into flexion while sleeping. The client may complain of a loss of tactile sensitivity in the fingers. Eventually, motor dysfunction will appear and is evidenced by clumsiness, loss of dexterity, and weakening of grip strength in the hand. The median nerve innervates most of the finger-flexor muscles. Thus, grip strength is affected.
Several physical-examination procedures are commonly used to identify CTS. The most common is the Phalen's test. In this test, the client presses the backside of his/her hands together and holds them for about 60 seconds. If neurological symptoms are reproduced along the median-nerve distribution, there is a good indication the client has CTS. Another procedure used for identifying CTS is the tethered median-nerve stress test. In this procedure, the wrist is held in extension or partial hyperextension. The practitioner will pull the index finger into hyperextension as far as the client's range of motion will allow. If this movement reproduces the client's pain or neurological symptoms, it is considered a positive indication of CTS.
In cases where nerve compression is not severe, myofascial stretching applied over the flexor retinaculum has proven helpful in reducing the aggravating symptoms of CTS. Deep longitudinal stripping and compression-broadening methods can be used on the forearm flexors to regain optimum tone in those tissues.In addition to specific techniques that focus on the wrist flexors or the carpal-tunnel region, for CTS it is important to address all the regions of the upper extremity and the neck. The median nerve may be compressed in a number of other locations, and this could further irritate the nerve at the carpal tunnel.
In addition to specific techniques that focus on the wrist flexors or the carpal-tunnel region, for CTS it is important to address all the regions of the upper extremity and the neck. The median nerve may be compressed in a number of other locations, and this could further irritate the nerve at the carpal tunnel. In some cases the median nerve is entrapped in one of these other locations, and not in the carpal tunnel, though the symptoms may be identical. For example, the nerve could be trapped where it travels between the two heads of the pronator teres muscle, which is called pronator teres syndrome. Too frequently, median-nerve entrapment is not thoroughly treated because attention is focused only on the carpal tunnel and not on these related areas throughout the upper extremity.
Still, the most commonly used surgical technique for CTS is the release of the ligament. This procedure is performed by cutting the transverse carpal ligament in order to reduce compression of the tunnel's contents against the ligament. This procedure is controversial because of the possibility of compromised wrist biomechanics after surgery. In addition, post-surgical scarring may further compress or bind the median nerve, causing the symptoms to recur. | | |
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