The Challenges of Carpal Tunnel Syndrome
Carpal Tunnel Syndrome (CTS) is one of the most common “peripheral neuropathies” patients have when they visit a chiropractor for the first time. Peripheral neuropathy (PN) is defined as “…damage or disease affecting nerves, which may impair sensation, movement, gland or organ function, or other aspects of health, depending on the type of nerve affected.” Let’s take a closer look!
Common causes of PN include systemic conditions such as diabetes, vitamin deficiency, medication side effects (such as chemotherapy meds), traumatic injury, after radiation therapy, excessive alcohol intake, an autoimmune disease such as rheumatoid arthritis, and/or viral infection. PN can be linked to an individual’s genetics that are present from birth. For others, it can be unknown which is then referred to as “idiopathic.”
PN can affect one nerve (mononeuropathy) or multiple nerves (polyneuropathy) and can be acute (which means it comes on quickly) or chronic (which means it comes on gradually over time and progresses slowly). PN symptoms can include cramp/charley horse-like pain, muscle twitching, muscle atrophy or shrinkage, numbness, tingling, pins and needles, burning or cold feeling, and can also affect other tissues such as bone causing degeneration, skin changes, and hair and nail changes. PN can also affect a patient’s balance and coordination which can increase an individual’s chances of falling. If organs or glands are also impacted, PN can lead to poor bladder control, heart rate or blood pressure changes, and/or affect the sweat glands.
Getting back to CTS specifically, one of the challenges of this condition is determining the cause/s. Here’s what we know about CTS: 1) it is more common in women than men; 2) it is more common in those who are overweight; 3) it is more common in those who work in highly repetitive environments; 4) it is more common over age 50; 5) it is often accompanied by other upper extremity “over-use” conditions like tendonitis in the hand, wrist, elbow, and/or shoulder and can also involve the neck (as CTS cases improve faster when treatment is also applied to the cervical spine); and 6) it commonly includes one or more of the conditions previously mentioned that can cause neuropathy such as diabetes and rheumatoid arthritis. Other conditions such as hypothyroid can also cause or worsen an existing case of CTS, in part due to “myxedema,” a type of swelling that occurs with this condition. Here, the additional swelling can add to the compression or pressure pushing on the median nerve in the carpal tunnel and either cause CTS or worsen an existing case.
Because CTS can have more than one underlying cause, it’s important that your doctor determine as many as possible in order to achieve the best treatment results. We’ve all heard of the cases that fail to respond to surgical intervention, which in many cases is because there were MULTIPLE CAUSES and only one was addressed with the surgical approach. Surgery has always been described as “the last resort” and indeed it’s appropriate in some cases. However, MANY CTS patients respond well to chiropractic management, which often includes (but is not limited to): 1) joint manipulation and mobilization of the hand, wrist, forearm, elbow, shoulder, and neck; 2) use of a night-time splint; 3) home/work exercises; 4) physical therapy modalities; 5) nutritional considerations; and 6) ergonomic modifications (work station assessment). If these approaches fail to achieve satisfying results, your doctor will refer you to a hand surgeon to determine which procedure might be best for you.