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You're working at your desk, trying to ignore the tingling or numbness you've had for months in your hand and wrist. Suddenly, a sharp, piercing pain shoots through the wrist and up your arm. Just a passing cramp? More likely you have carpal tunnel syndrome, a painful progressive condition caused by compression of a key nerve in the wrist.
What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers (although not the little finger), as well as impulses to some small muscles in the hand that allow the fingers and thumb to move. The carpal tunnel - a narrow, rigid passageway of ligament and bones at the base of the hand - houses the median nerve and tendons. Sometimes, thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed. The result may be pain, weakness, or numbness in the hand and wrist, radiating up the arm. Although painful sensations may indicate other conditions, carpal tunnel syndrome is the most common and widely known of the entrapment neuropathies in which the body's peripheral nerves are compressed or traumatized.
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What are the Symptoms of Carpal Tunnel Syndrome?
Symptoms usually start gradually, with frequent burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers. Some carpal tunnel sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent. The symptoms often first appear in one or both hands during the night, since many people sleep with flexed wrists. A person with carpal tunnel syndrome may wake up feeling the need to "shake out" the hand or wrist. As symptoms worsen, people might feel tingling during the day. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In chronic and/or untreated cases, the muscles at the base of the thumb may waste away. Some people are unable to tell between hot and cold by touch.
What Are the Causes of Carpal Tunnel Syndrome?
Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel, rather than a problem with the nerve itself. Most likely the disorder is due to a congenital predisposition - the carpal tunnel is simply smaller in some people than in others. Other contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture; overactivity of the pituitary gland; hypothyroidism; rheumatoid arthritis; mechanical problems in the wrist joint; work stress; repeated use of vibrating hand tools; fluid retention during pregnancy or menopause; or the development of a cyst or tumor in the canal. Carpal tunnel syndrome is also associated with pregnancy and diseases such as diabetes, thyroid disease, or rheumatoid arthritis. In some cases no cause can be identified.
There is little clinical data to prove whether repetitive and forceful movements of the hand and wrist during work or leisure activities can cause carpal tunnel syndrome. Repeated motions performed in the course of normal work or other daily activities can result in repetitive motion disorders such as bursitis and tendonitis. Writer's cramp - a condition in which a lack of fine motor skill coordination and ache and pressure in the fingers, wrist, or forearm is brought on by repetitive activity - is not a symptom of carpal tunnel syndrome.
Who is at risk of developing Carpal Tunnel Syndrome?
Women are three times more likely than men to develop carpal tunnel syndrome, perhaps because the carpal tunnel itself may be smaller in women than in men. The dominant hand is usually affected first and produces the most severe pain. Persons with diabetes or other metabolic disorders that directly affect the body's nerves and make them more susceptible to compression are also at high risk. Carpal tunnel syndrome usually occurs only in adults.
The risk of developing carpal tunnel syndrome is not confined to people in a single industry or job, but is especially common in those performing assembly line work - manufacturing, sewing, finishing, cleaning, and meat, poultry, or fish packing. In fact, carpal tunnel syndrome is three times more common among assemblers than among data-entry personnel. A 2001 study by the Mayo Clinic found heavy computer use (up to 7 hours a day) did not increase a person's risk of developing carpal tunnel syndrome.
During 1998, an estimated three of every 10,000 workers lost time from work because of carpal tunnel syndrome. Half of these workers missed more than 10 days of work. The average lifetime cost of carpal tunnel syndrome, including medical bills and lost time from work, is estimated to be about $30,000 for each injured worker.
How is Carpal Tunnel Syndrome diagnosed?
Early diagnosis and treatment are important to avoid permanent damage to the median nerve. A physical examination of the hands, arms, shoulders, and neck can help determine if the patient's complaints are related to daily activities or to an underlying disorder, and can rule out other painful conditions that mimic carpal tunnel syndrome. The wrist is examined for tenderness, swelling, warmth, and discoloration. Each finger should be tested for sensation, and the muscles at the base of the hand should be examined for strength and signs of atrophy. Routine laboratory tests and X-rays can reveal diabetes, arthritis, and fractures.
Physicians can use specific tests to try to produce the symptoms of carpal tunnel syndrome. In the Tinel test, the doctor taps on or presses on the median nerve in the patient's wrist. The test is positive when tingling in the fingers or a resultant shock-like sensation occurs. The Phalen, or wrist-flexion, test involves having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together. The presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, is felt in the fingers within 1 minute. Doctors may also ask patients to try to make a movement that brings on symptoms.
Often it is necessary to confirm the diagnosis by use of electrodiagnostic tests. In a nerve conduction study, electrodes are placed on the hand and wrist. Small electric shocks are applied and the speed with which nerves transmit impulses is measured. In electromyography, a fine needle is inserted into a muscle; electrical activity viewed on a screen can determine the severity of damage to the median nerve. Ultrasound imaging can show impaired movement of the median nerve. Magnetic resonance imaging (MRI) can show the anatomy of the wrist but to date has not been especially useful in diagnosing carpal tunnel syndrome.
How is Carpal Tunnel Syndrome treated?
Treatments for carpal tunnel syndrome should begin as early as possible, under a doctor's direction. Underlying causes such as diabetes or arthritis should be treated first. Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint to avoid further damage from twisting or bending. If there is inflammation, applying cool packs can help reduce swelling.
Specific tests will be performed to see if spinal nerves are involved.
Specific chiropractic adjustments can help return malfunctioning joints to a more normal motion and position.
The major nerve controlling the thumb, index, and parts of the middle, and ring finger is called the median nerve. From the tip of your fingers, it travels through the bones in your wrist, past your elbow, up your arm, through your shoulder and neck, and finally to your spinal cord. Problems can develop in one or more of these areas.
The carpal “tunnel” is formed by bones in the wrist. The median nerve, tendons, and blood vessels pass through this opening. If one or more of the bones forming this tunnel should “collapse”, inflammation, nerve pressure, and painful symptoms can result.
The median nerve connects to the spinal cord through openings between several bones in the lower neck. When these spinal bones lose their normal motion or position, they can cause problems in the fingers and wrist.
After a thorough examination, your chiropractic doctor will perform specific adjustments where needed, to help normalize structure and reduce nerve irritation. When given time, conservative, chiropractic care has produced excellent results with carpal tunnel problems----without drugs or surgery.
Repetitive hand and wrist motions
Every day, assembly line workers, keyboard operators, grocery store clerks, and many others, receive micro-traumas to their hands and wrists. Vibration and repetitive motions, when combined with spinal problems and other joint dysfunction, can result in a condition known as carpal tunnel syndrome.
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About Dr. Lu
Dr. Lu completed his medical education and training in China. (The Chinese Academy of Medical Sciences and Shandong University Medical College respectively) Over 20 years clinic and research experiences in both medical school and hospital, Dr. Lu learned both West Medicine and Traditional Chinese Medicine including modern medical technology, acupuncture, medicinal herbs, and specializing in neurology. After years practice and accomplishments in China, Dr. Lu was invited as a visiting professor at the University of South Carolina, School of Medicine in 1991. After excellent achievements in research program funded by NIH and NSF, Dr. Lu decided to become a Doctor of Chiropractic in order to introduce the Traditional Chinese Medicine to the Western culture. Obtained Doctor Degree of Chiropractic from Parker College of Chiropractic, Dr. Lu became a licensed Doctor of Chiropractic and Board Permit in Acupuncture, then and began his practice in Dallas Texas since then. Dr. Lu learned NAET and became a NAET Instructor in 2003 and 2014 respectively. In 2007 Dr. Lu was voted the best Acupuncturist in the City of Richardson by Living Magazine. In 2013, Dr. Lu was rated the Best Chiropractor in City of Plano. In 2014 advanced to America's Top Chiropractors specialized in Natural Medicine. |
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