Carpal Tunnel Syndrome

Carpal-Tunnel-Syndrome-2Possibly the most familiar type of repetitive strain injury is carpal tunnel syndrome.  Most people have heard this term or know someone who has suffered from it.  In order to understand what happens, it is first important to know a little bit of anatomy:

At the base of your palm, where your wrist begins, the bones and ligaments literally form a tunnel through which many important structures pass.  The muscles that control your fingers are not located in your hand at all, but in your forearm.  These muscles connect to your fingers with long tendons, like the strings of a marionette puppet.  When the muscle in your arm contracts, it pulls on the tendon or “string” and moves the finger with it.  If you press your thumb in different areas between your wrist and your elbow and then wiggle your fingers, you’ll be able to feel those tendons moving.  It’s really quite a fascinating and intricate system!  Anyway, these tendon “strings” pass through the tunnel that I mentioned earlier, as does the median nerve – all in a neatly organized and compartmentalized fashion.  Under normal circumstances, everything moves and slides perfectly and you can do all sorts of things with your hands, fingers and wrists without any pain or restriction.

Unfortunately, small, rapid, repetitive movements such as typing on a computer keyboard can irritate some of these tissues to the point where they can get damaged and inflamed.  When they swell up it decreases the space available for the sensitive nerve tissue.  When this happens, you’ll get numbness and tingling in the thumb, index and middle finger (and part of the ring finger).  Conservative treatment for carpal tunnel includes things like manual massage, ultrasound, laser therapy and anti-inflammatories.  Sometimes splints are worn at night to keep the wrist straight in order to maximize the tunnel space.  In more serious cases, where conservative methods have failed, surgery is sometimes indicated to physically widen and open up the tunnel.  This option should be considered very carefully, since there are many potential side-effects of surgery.  One of the major reasons for unsuccessful surgery is an incorrect diagnosis in the first place!

Here’s why:  The nerve passing through the carpal tunnel is the median nerve, and the symptoms of carpal tunnel directly relate to this nerve being irritated.  The problem is that a person may have the same symptoms if there is irritation to the nerve higher up.  So a person could be diagnosed with carpal tunnel syndrome, when in fact there is nothing wrong with that structure, but the median nerve is being irritated at the elbow, in the armpit or in the neck.  In fact there are at least 8 points along the course of the median nerve that can be irritated.  This is where I come in!  I have treated several patients who thought they had carpal tunnel syndrome, but it turned out they just had joint restriction in their necks.  When chiropractic adjustments were performed, the nerve irritation was relieved and the symptoms went away.  So the moral of this story is – Make sure you actually have a problem in your carpal tunnel BEFORE you have surgery.
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