Carpal tunnel syndrome (CTS) is the most expensive of
all work-related injuries. Over his or her lifetime, a
carpal tunnel patient loses about $30,000 in medical
bills and time absent from work.
CTS typically occurs in adults, with women 3 times more
likely to develop it than men. The dominant hand is
usually affected first, and the pain is typically
severe. CTS is especially common in assembly-line
workers in manufacturing, sewing, finishing, cleaning,
meatpacking, and similar industries. Contrary to the
conventional wisdom, according to recent research,
people who perform data entry at a computer (up to 7
hours a day) are not at increased risk of developing
What Is CTS?
CTS is a problem of the median nerve, which runs from
the forearm into the hand. CTS occurs when the median
nerve gets compressed in the carpal tunnel—a narrow
tunnel at the wrist—made up of bones and soft tissues,
such as nerves, tendons, ligaments, and blood vessels.
The compression may result in pain, weakness, and/or
numbness in the hand and wrist, which radiates up into
the forearm. CTS is the most common of the “entrapment
neuropathies”—compression or trauma of the body’s nerves
in the hands or feet.
What Are the Symptoms?
Burning, tingling, itching, and/or numbness in the palm
of the hand and thumb, index, and middle fingers are
most common. Some people with CTS say that their fingers
feel useless and swollen, even though little or no
swelling is apparent. Since many people sleep with
flexed wrists, the symptoms often first appear while
sleeping. As symptoms worsen, they may feel tingling
during the day. In addition, weakened grip strength may
make it difficult to form a fist or grasp small objects.
Some people develop wasting of the muscles at the base
of the thumb. Some are unable to distinguish hot from
cold by touch.
Why Does CTS Develop?
Some people have smaller carpal tunnels than others,
which makes the median nerve compression more likely. In
others, CTS can develop because of an injury to the
wrist that causes swelling, over-activity of the
pituitary gland, hypothyroidism, diabetes, inflammatory
arthritis, mechanical problems in the wrist joint, poor
work ergonomics, repeated use of vibrating hand tools,
and fluid retention during pregnancy or menopause.
How Is It Diagnosed?
CTS should be diagnosed and treated early. A standard
physical examination of the hands, arms, shoulders, and
neck can help determine if your symptoms are related to
daily activities or to an underlying disorder.
Dr. Conboy can use other specific tests to try to
produce the symptoms of carpal tunnel syndrome. The most
- Pressure-provocative test. A cuff placed at the
front of the carpal tunnel is inflated, followed by
direct pressure on the median nerve.
- Carpal compression test. Moderate pressure is
applied with both thumbs directly on the carpal
tunnel and underlying median nerve at the transverse
carpal ligament. The test is relatively new.
Laboratory tests and x-rays can reveal diabetes,
arthritis, fractures, and other common causes of wrist
and hand pain. Sometimes electrodiagnostic tests, such
as nerveconduction velocity testing, are used to help
confirm the diagnosis. With these tests, small
electrodes, placed on your skin, measure the speed at
which electrical impulses travel across your wrist. CTS
will slow the speed of the impulses and will point Dr.
Conboy to this diagnosis.
What Is the CTS Treatment?
Initial therapy includes:
- Resting the affected hand and wrist
- Avoiding activities that may worsen symptoms
- Immobilizing the wrist in a splint to avoid
further damage from twisting or bending
- Applying cool packs to help reduce swelling from
Some medications can help with pain control and
inflammation. Studies have shown that vitamin B6
supplements may relieve CTS symptoms.
Chiropractic joint manipulation and mobilization of the
wrist and hand, stretching and strengthening exercises,
soft-tissue mobilization techniques, and even yoga can
be helpful. Scientists are also investigating other
therapies, such as acupuncture, that may help prevent
and treat this disorder.
Occasionally, patients whose symptoms fail to respond to
conservative care may require surgery. The surgeon
releases the ligament covering the carpal tunnel. The
majority of patients recover completely after treatment,
and the recurrence rate is low. Proper posture and
movement as instructed by your doctor of chiropractic
can help prevent CTS recurrences.
How Can CTS Be Prevented?
The American Chiropractic Association recommends the
- Perform on-the-job conditioning, such as
stretching and light exercises.
- Take frequent rest breaks.
- Wear splints to help keep the wrists straight.
- Use fingerless gloves to help keep the hands
warm and flexible.
- Use correct posture and wrist position.
- To minimize workplace injuries, jobs can be
rotated among workers. Employers can also develop
programs in ergonomics—the process of adapting
workplace conditions and job demands to workers’
Source: The American Chiropractic