Carpal Tunnel Syndrome

What is it?

Before explaining the syndrome, it is important to understand the associated anatomy.

The carpal tunnel is a restricted place at the front of the wrist, bounded by ligaments, through which pass the tendons that flex the fingers and wrist. This space is roofed over by a tough ligament, called the flexor retinaculum which prevents the tendons from pulling away from the wrist when it is bent. One of the two sensory nerves to the hand, the median nerve, also passes through the carpal tunnel and there is little or no room for expansion.

Any swelling in the region, from any cause, will, therefore, tend to compress the median nerve and interfere with the conduction of nerve impulses. The result is numbness and tingling, sometimes even pain, in the half of the hand on the thumb side which is supplied by the nerve.

The carpal tunnel is significant because of the common occurrence of compression within it, particularly of the median nerve.

Carpal tunnel syndrome occurs most commonly in women of middle age although the disease causing agent of this common condition is still poorly understood.

Can it occur on both hands?

The spontaneous condition is frequently on both hands but often begins in one hand some months or longer before it begins on the other. Early symptoms are pain and tingling felt in the fingers. This tingling is often most troublesome at night or waking in the morning.

Numbness in these fingers renders the handling of small objects difficult and is accompanied by the weakening of the tendons in the wrist and the resulting weakness in opposition further the clumsiness of the hand.

 

 

  

How can it be treated?

If there are no fractures or dislocations on the wrist then it is assumed that it is definitely carpal tunnel syndrome- at this stage a chiropractor can help greatly. Chiropractors not only specialise in treating spinal problems but also any mechanical and other problems with the extremities.

The treatment consists of splinting of the wrist during the day and if possible the night also. This not only relieves the symptoms but breaks the cycle of swelling and pain. Analysis of the mechanical causes of the problem then must occur, e.g. ergonomic evaluation of the patient’s workstation, to eliminate the cause. At this time some ultrasound therapy at the wrist to help disperse swelling is useful.

This can be combined with gentle mobilisation or gentle mobilisation or gentle chiropractic manipulation of the wrist bones to help establish space in the tunnel which has been lost due to prolonged swelling.Other joints are also assessed for any secondary or associated problems, these include elbow and shoulder. The cervical (neck) and thoracic (chest) spine are also checked.

Will pain killers help?

Anti-inflammatory drugs have been shown to be of some assistance during this period. Vitamin B6 and magnesium can also be helpful.

Can it be confused with other conditions?

This condition must be differentiated from the beginnings of multiple sclerosis and arthritis. What it can be compared to is RSI which has similar symptoms e.g. tingling, coldness, sensory and motor loss and numbness sensation felt in the fingers.

Are recurrences likely?

There shouldn’t be, but if this treatment fails it is only then that surgery to cut the overlying carpal ligament should be considered. Steroidal injection into the carpal tunnel ahs been used as an alternative but has not proven to give any lasting therapeutic benefit.