Carpal Tunnel

Carpal tunnel syndrome (CTS) is a condition caused by swelling and pressure inside a tunnel-like structure of the wrist called the carpal tunnel. The carpal tunnel is made up of the 8 small bones (carpal bones) at the base of the hand, and a ligament, or fibrous tissue, joining those bones together. Passing through the carpal tunnel are the flexor tendons–connective tissue that allows the fingers to move–and the median nerve, which runs from the forearm into the hand. Any repetitive motion that causes the wrist to flex and extend–such as typing, knitting, assembly work, or playing the piano–may result in swelling and thickening of the protective sheaths surrounding each of the tendons. This swelling, in turn, causes pressure on the median nerve, which serves as a pathway for sensory cells in the hand. When this nerve is compressed, symptoms of CTS–which may include tingling, numbness, pain, or weakness in the fingers, wrist, or arm–may appear. In addition to repetitive motion, injury or diseases such as arthritis, diabetes, or thyroid disorders may lead to CTS. Women are 3 times more likely to develop the disease than men because, some think, the carpal tunnel is often smaller in women than in men.

HOW BLAIR UPPER CERVICAL TREATMENT CAN HELP

The standard medical approach to treating CTS may include a splint to immobilize the wrist, diuretics (water pills), anti-inflammatory drugs, or corticosteroid shots to reduce swelling. As a last resort, surgery may be performed, but recovery may take months or years, and even if the pain is eliminated, symptoms may return over time.

In the BLAIR UPPER CERVICAL TREATMENT approach, it is important not only to treat symptoms but also to determine the cause of the problem. The NUCCA practitioner usually examines the neck and spine before the wrist. There are a group of nerves that come out of the mid- to lower-neck region and branch out to the arms, hands, and fingers. Pressure on any of these nerves, especially the median nerve, may result in CTS.

Specific imaging studies of the cervical (upper neck) region are taken to locate a misalignment of the vertebrae. TYTRON-5000 technology is used to scan and measure the nervous system for possible irritation. If a misalignment has been found to affect nerve function in the wrist, then very specific gentle adjustments are made, by hand, to correct the misaligned vertebrae in the neck. Once the spinal correction is accomplished successfully, normal nerve function is restored to the wrist, and many patients with CTS find relief.

SOURCES

National Institute of Arthritis and Musculo-skeletal and Skin Diseases Web site. Available at: http://www.niams.nih.gov. Accessed March 6 , 2005

National Institute of Neurological Disorders and Stroke Web site. Available at: http://www.ninds.nih.gov/disorders/carpal/carpal.htm. Accessed: March 7, 2005.

Peddie S, Rosenberg CH. The Repetitive Strain Injury Sourcebook. Lincolnwood , Ill : Lowell House, 1998.

USEFUL LINKS

  • Carpal Tunnel Syndrome Home Page
  • Useful starting point for information about CTS as well as ergonomic equipment and resources.
  • http://www.ctsplace.com
  • National Institute for Occupational Safety and Health
  • Branch of the Centers for Disease Control and Development; good source of information on cumulative stress disorders, including CTS, and healthy workplace environment.
  • http://www.cdc.gov/niosh
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases
  • Part of the National Institutes of Health; offers useful information on CTS for patients.
  • http://www.niams.nih.gov/an/index.htm

Carpal Tunnel

Carpal tunnel syndrome is a debilitating disorder caused by irritation or pressure to the median nerve. The median nerve originates in the neck, runs through the shoulder, arm and forearm into the wrist and hand.

Carpal Tunnel and the Upper Cervical Spine

Problems in the neck or cervical spine can be as simple as poor posture and muscle tension, or as serious as disc bulges, arthritis, or spinal misalignments, also referred to as subluxations.

A proper evaluation for CTS should include an exam of the entire length of the median nerve, starting at the neck and working down to the hands, wrists and fingers. Since the neck is the most common site for Double Crush to occur, a consultation with an Upper Cervical doctor would be in the best interests of any CTS sufferer, especially if they have been recommended for carpal tunnel surgery.

The purpose of Upper Cervical care is to correct misalignments in the neck that produce irritation to the nerve roots that extends to the wrist, hands and fingers. Clinical findings document that this can prevent the need for surgery.

Carpal Tunnel Syndrome (CTS) is a debilitating disorder caused by irritation or pressure to the median nerve which originates in the neck, runs through the shoulder, arm and forearm, and into the wrist and hand. It is one of the major nerves in the hand that provides sensation and movement for the thumb, index and middle fingers. CTS is often described as an aching pain with burning, tingling, and numbness in the wrist or hand and, occasionally, in the forearm. In some cases, muscle weakness, swelling and loss of temperature sensation may be present. Sufferers of carpal tunnel may begin to drop objects or have difficulty lifting small items or turning doorknobs.

Some think there is a higher incidence of CTS among those who do work which requires them to use their hands, wrists, or arms in a repetitive manner, but renowned hand surgeon, Dr. Charles Eaton, says there is no scientific evidence that shows such activities actually cause carpal tunnel syndrome.

Double Crush Syndrome & Carpal Tunnel

Stress to the median nerve commonly begins in the neck (Diagram #1 – cervical spine), where the median nerve begins. The nerve is then aggravated by added pressure or irritation anywhere from the neck to the wrist (Diagram #2), which can then cause symptoms in the hand and fingers. This is called “Double Crush syndrome” and is widely referenced in the scientific and medical research journals as a consistent finding in patients with carpal tunnel syndrome. Pressure or irritation to the nerve roots as they exit the neck makes the median nerve more vulnerable to injury at the wrist.

A growing number of studies suggest that the Double Crush phenomenon is one of the most common causes of CTS. The prestigious medical journal, The Lancet, found that nearly 7 of every 10 CTS patients had nerve irritation in the neck. Another study found that 89% of carpal tunnel sufferers also had arthritis in the neck. Both studies suggest the vast majority of CTS patients actually have Double Crush phenomena.

This would explain the high failure rate of common medical treatments for carpal tunnel syndrome. Treatments directed solely at the wrist neglect possible nerve irritation or compression in the neck, which renders the lower nerves in the wrist more susceptible to injury. In this case, it is essential to first correct the cervical problem to allow the wrist condition to fully heal. A similar phenomenon can also occur with Thoracic Outlet Syndrome (TOS) and cervical radiculopathy (tingling, pain down the arms).

Carpal Tunnel Syndrome (CTS) results from impingement of the Median Nerve, which runs from the neck, down the arm, then through bones in the wrist (carpal tunnel), to supply the hand and thumb. Irritation to this nerve often results in numbness, tingling, and pain in the hand and thumb, loss of grip strength in the hand and thumb, and pain / numbness radiating from the neck and arm.

How Upper Cervical Care Relates to Carpal Tunnel Syndrome

In a review of medically confirmed carpal tunnel syndrome cases, it was discovered that the majority of patients examined also had concurrent problems with the cervical spine.1 Because nerve roots from the cervical spine form the median nerve in the arm, it has been suggested that cervical problems can contribute to the onset of CTS.2-18 Many of these patients do not respond to conservative and/or surgical treatment directed solely at the wrist. Because cervical nerve irritation and/or compression renders the lower nerves in the wrist more susceptible to injury, it is essential to properly correct the cervical problem first if the wrist condition is to fully resolve.

The purpose of upper cervical care is to correct cervical spine mechanics that are irritating spinal cord tracts and nerve roots that extend to the wrist. A similar phenomenon can occur with Thoracic Outlet Syndrome (TOS) and cervical radiculopathy (tingling, pain down the arms). While many carpal tunnel sufferers recall specific traumas such as head injuries, auto accidents or falls, which could have injured their cervical spines, some do not. An evaluation is necessary in each individual’s case to assess whether an upper cervical injury is present and whether benefit from upper cervical care can be achieved.

 

Case Studies – Carpal Tunnel Syndrome

Male, Age 34 years, Carpal Tunnel Syndrome, Numbness & Tingling in Hand and Thigh

After working for 10 years as an engineer and spending most of his days on a computer, this 34-year-old male was diagnosed with carpal tunnel syndrome. His symptoms included pain, numbness and tingling, and muscle weakness in his right wrist and hand, and sharp pain in his neck and shoulders. Occasionally, his neck “locked up” and he could not move it due to pain. In addition, he tapped his right leg while working on the computer and experienced numbness, tingling, and muscle weakness in his right thigh. Over the past 10 years, he tried many forms of health care with no success, including general chiropractic, wrist braces, anti-inflammatory drugs, rest, exercises, etc.

During this patient’s initial examination, extreme weakness in his right hand was noted during grip strength testing and wrist extension. Right hip flexion also was weak. An upper neck injury was discovered during x-ray and thermographic examination. After the first upper cervical adjustment, the muscle strength in his wrist, hand, and thigh was 90% restored, and the numbness and tingling in both his hand and thigh were completely gone. Range of motion in his neck was greatly improved. After 1 month of care, he was pain-free and symptom-free, while still working on the computer 8 hours per day.

Male, Age 44 years, Carpal Tunnel Syndrome, Neck Pain

This 44-year-old male described suffering from carpal tunnel syndrome (CTS) for close to 10 years. He suffered from pain and tingling from his right hand, up his arm, to his neck. He had been forced to leave at least one computer job due to the severity of his symptoms. When questioned about the timing of the onset of his symptoms, he recalled a bad fall skiing, which preceded the onset of his symptoms. During this skiing incident, he fell down a cliff and somersaulted on his head and thought this fall might have injured his neck. His CTS symptoms began after the skiing fall and continued ever since.

An upper cervical chiropractic evaluation was performed and an injury was discovered through thermographic and radiographic testing. After the first upper cervical correction, he felt immediately relief in his hand, arm, and neck. After receiving treatment over the subsequent weeks to stabilize his neck, he reported absence of all symptoms and was able to resume working full time at a computer job.