St. Louis Chiropractic Care For Carpal Tunnel & Wrist Pain
This is a very common injury that involves numbness and soreness in the hand. It impacts more women than men.
The ‘carpal tunnel’ is a thin, tunnel-like structure that is located in the wrist. The carpal tunnel itself is formed at the bottom and on the sides by the wrist bones and at the top is a piece of connective tissue that is commonly known as the transverse carpal ligament.
The median nerve also travels from the arm into the hand through this area. This nerve is responsible for feeling in your palm and fingers. Also found in this tunnel area are the ‘flexor’ tendons that control the fingers and thumb.
What Causes Carpal Tunnel Syndrome?
This ailment happens when the soft tissues that go around the flexor tendons swell and in turn then put pressure on the median nerve. These soft tissues are called the synovium and its function is to lubricate the tendons so finger movement is easier. As the synovium swells it tends to crowd the nerve in the carpal tunnel area and pain and numbness result.
Here are some contributing factors to carpal tunnel syndrome:
- Heredity – this is because in some families the carpel tunnel is genetically smaller than in other families.
- Repetitive hand use over time plays a part.
- Pregnancy hormonal changes can be a factor
- Age – it is more common in the elderly
- Medical conditions – thyroid imbalances, diabetes and rheumatoid arthritis are some of the ailments that tend to hasten the onset of carpel tunnel syndrome.
It is worth noting that in a majority of cases carpal tunnel syndrome has no single cause.
The common symptoms associated with carpal tunnel syndrome are:
- Pain, tingling, and numbness in the hand
- A feeling like an electric shock felt mostly in the long fingers and thumb.
- Pain and strange sensations that go up into the arm.
Carpal Tunnel symptoms usually come on gradually over time and are not related to one specific injury. Most people experience stronger symptoms on the thumb side of the hand. Symptoms at night are not uncommon because many people sleep with their wrists curled and it may even wake a person from their sleep. Simple things such as holding a phone or holding a book may bring on symptoms. Moving the hand or shaking will often times lessen the severity of the symptoms.
Symptoms usually come and go at first but tend to remain more constant over time.
Diagnosis of Carpal Tunnel Syndrome
If medical help is sought for carpel tunnel syndrome they will take a look at the patient’s medical history, discuss their symptoms and do a physical examination.
Here is what the physical exam will normally include:
- Examine for weakness the muscles at the base of the thumb
- Adjusting the wrist in several positions to see if it brings on tingling or numbness
- Applying pressure to the median nerve to see if pressure or numbness results
- Tapping the median nerve to see if it causes tingling
- Examining the feeling in the fingers by lightly touching them when the patients eyes are closed
Tests to determine Carpal Tunnel Syndrome
- Electrophysiological tests – this tests median nerve function.
- X-rays – only done when wrist motion is severely limited.
Chiropractic & Other Treatments
In most cases carpal tunnel syndrome will only get worse without some form of treatment. If caught in the early stages treatment is often very successful and can be done without the need for surgery.
- Bracing or splinting
Using a brace or splint at night keeps the wrist in a neutral position. This is effective for people who sleep with their wrists curled because it keeps pressure off the median nerve. Splints are also often worn during activities that aggravate carpal tunnel syndrome symptoms.
Anti-inflammatory drugs like Ibuprofen will usually help alleviate some of the symptoms such as pain.
- Activity changes
Techniques such as changing the pattern of hand use and avoiding positions that tend to aggravate the symptoms are sometimes helpful. If the onset of carpal tunnel syndrome is work related then changing jobs or job related tasks may slow or completely stop the progression of the ailment.
- Steroid injections
Corticosteroid injections will quite often provide relief but symptoms might still come back.
If non-surgical treatments do not bring relief then surgery is an option. This decision is almost always based on the severity of the symptoms.
- In very severe cases surgery is considered sooner because non-surgical methods of treatment most likely will not work.
- Other candidates for surgery include those cases where constant numbness is wasting away the thumb muscles and might lead to irreparable damage.
Carpal tunnel surgery is most always done on an outpatient basis using a local anesthesia. During the process a small incision is made in the palm of the patient’s hand. The carpal tunnel ligament is then divided to increase the size of the carpal tunnel and in turn decrease some of the pressure on the nerve. Once closed the ligament grows as it heals and this creates more space for the median nerve and flexor tendons.
Endoscopic method – some surgeons will do this surgery in a slightly different manner. They will make just a very small incision and use a camera called and endoscope to make the cut the ligament. This often speeds up recovery time.
Here are the most common problems associated with carpal tunnel surgery:
- Injury to the Nerve
In a vast majority of the cases a patient’s symptoms will improve after the surgical process. Recover happens at different rates for different patients and may be very gradual. It usually takes around 2 months for pinching and gripping strength to return and complete recovery happens at around a year for most patients. If pain and weakness continue for over two months your doctor may instruct you to see a hand therapist.
For more severe cases that involve loss of feeling and the wasting away of the thumb muscle recovery time is typically longer and a full recovery may not ever take place. On rare occasions carpal tunnel syndrome may reappear and more surgery may be required.