Management
Strategies
Many patients ask whether I
treat conditions like carpal tunnel syndrome.
Once it is clear that we do indeed treat this common condition, the
discussion turns to the topic of the different treatment strategies that exist.
Usually patients are surprised to learn that chiropractic approaches are very
effective for this condition. In fact,
questions about CTS frequently do not occur until after a few visits addressing
other complaints, as patients often do not associate chiropractors as a
treatment option for CTS.
Interestingly, it is the rule
rather than the exception that carpal tunnel syndrome is accompanied with other
conditions also caused by repetitive types of activities such as work duties
and/or hobbies. Therefore, a very
important treatment strategy is educating the patient about the causes of CTS
and other repetitive motion injuries that usually accompany CTS. It is important to include information regarding
four common aspects that relate to causation, which include: 1.
Force, 2. Repetition, 3. Faulty posture, and, 4. No rest time.
The net result of these four items is overuse injuries referred to as
cumulative trauma disorders (CTDs).
One of the leading types of CTDs
is carpal tunnel syndrome. However,
because over utilization typically precedes the onset of carpal tunnel
syndrome, other types of conditions affecting the entire upper extremity such
as tennis elbow, shoulder bursitis, as well as neck pain secondary to muscle
guarding must be included in the evaluation process. Once all the conditions are identified, the
next important aspect in the management process is gaining an understanding of
the patient's work and/or hobbies as a successful outcome is dependent on
identifying faulty workstations and modifying the work environment so that
repetitive forces in awkward positions can be corrected. The most successful management approaches
stem from discussions with the patient regarding these important aspects of the
condition, as the most effective treatment approach may be totally ineffective
without rectifying a faulty workstation.
An example of a common
workstation cause includes placing a computer keyboard on top of a desk instead
of underneath the desk in a pull out type of drawer. This is because any extreme position of the
wrist when it has to bend to 90 degrees creates significant pressure inside the
carpal tunnel as the nine tendons inside the tunnel slide back and forth during
finger movements. If the forearms are
resting on the edge of the desk while typing on the keyboard, this adds to the
pressure and increased friction to the sliding tendons resulting in tendonitis,
or inflammation of the tendons. Because
the carpal tunnel is a small confined space where a nerve and 9 tendons pass
from the forearm into the hand, even a small amount of swelling will result in
excessive pressure inside the tunnel, pushing the nerve upwards into the roof
of the tunnel or, the ligament that crosses the wrist. This results in numbness, tingling and
eventually weakness and complaints such as difficulty in buttoning shirt,
picking up small objects like pins, or unscrewing jar are common.
Once the workstation is properly
modified and the patient is properly educated so that excessive, repetitive
forces can be minimized, treatment approaches addressing each individual
injured region from the neck to the hand will be much more effective. We encourage you to ask us about managing
your carpal tunnel complaints and look forward to helping you, your family or
friends who have this problem.
