What is Carpal Tunnel?
This is a condition that is defined by tingling and numbness in the hand and arm which usually occurs gradually over time. It eventually leads to hand weakness and is due to an impingement of the median nerve which runs down the center of the forearm (when you are looking at your hand with the palm up). There are several factors that can cause it, but most are due to the persons anatomy or a repetitive action by the arm and hand most typically due to overuse on the computer. The bones of the palm form a tunnel that protects the nerve and the 9 tendons that helps the hand to function.
What are the Symptoms?
- Aching: One of the first symptoms to appear is not directly a symptom of Carpal tunnel but is a sort of “Canary in the Coal mine”, meaning it is the warning sign that tingling and numbness will follow. It is an urgent message to see a practitioner to make sure that your hands and forearm anatomy are in proper alignment so more serious symptoms don’t develop.
- Tingling and Numbness: Typically tingling is felt first, followed by numbness in the thumb, index and middle finger. The ring finger will sometimes be effected, and the little finger is usually not effected because it is controlled by another nerve. The sensation will be much like your hand has gone to sleep and you need to shake it to wake it up. As symptoms progress, the numbness may go from occasional to constant.
- Weakness: Often dropping items or not being able to grasp very well progresses over time making symptoms much worse. The most common weakness that occurs is the pinching movement of the thumb as this is controlled almost entirely by the median nerve.
What Causes Carpal Tunnel Syndrome?
It is a compression of the median nerve on the hand. Here are the most common ways to get carpal tunnel in our modern world:
- Repetitive jobs: assembly line work, dental, computer work, and some construction jobs
- Pregnancy: increased swelling will sometimes cause carpal tunnel like symptoms till baby is born.
- Women are more likely to get Carpal Tunnel due to having smaller carpal tunnels
- Dislocation of the hand/wrist
- Inflammatory conditions: Rheumatoid arthritis and many other disorders
- Work with Vibrational tools
This is only a small list and many other things also can cause this condition. Don’t assume you do not have carpal tunnel because your job factor isn’t listed here.
How is Carpal Tunnel Diagnosed?
It is done by a thorough history or examination of your symptoms to see if you have some of the risk factors and how the gradual onset of symptoms or the trauma occurred. The doctor will do a physical exam performing a series of orthopedic tests that put pressure on the Median Nerve in several different ways. An Xray may be ordered or an Magnetic Resonance Imaging (MRI) will be done to rule out other issues such as arthritis, neuroma or other anatomical variations that may be causing the issue. Lastly, a Nerve conduction study or a Surface Electromyography (EMG) study that will done to see if the median nerve is conducting a current all the way from the neck, elbow and into the palm. This is to make sure that nerve damage isn’t occurring which would need to be addressed with a surgical option immediately.
How is Carpal Tunnel Treated?
If your history and exam only reveal a mild onset of symptoms, you can see a chiropractor that specializes in adjustments and soft tissue injuries. We recommend that you see one that is specialized in the Graston Technique as it has been shown to be very effective for treating Carpal Tunnel and offers significant improvement in about 8 visits. Graston releases the tight muscles and adhesions caused in the palmar forearm and will need to be iced after treatment as some minor swelling may occur. Physical therapy may also be needed to strengthen areas of weakness that lead to the carpal tunnel issue originally as well as re-training those injured areas. Splints may be recommended to keep the tunnel open and your wrist in as optimal a position as possible. Corticosteroids are also tried if the previous more conservative treatments have failed. We do recommend Corticosteroids over surgery. Lastly if severe enough nerve compression is present, the patient will have to look at surgical options but we do recommend this as a last resort since the carpal tunnel is narrow and scar tissue can form post-surgically as well which causes further problems down the road.
We treat Carpal tunnel in our office and you can expect a combination of Graston therapy, Kinesio Tape and adjustments for the treatment regiment. This is an area great concern. Silicon Valley has a lot of Carpal Tunnel issues because of how many of us use computers, cell phones and tablets on a daily basis. Don’t wait for it to get so bad before getting it evaluated and treated.