Carpal Tunnel Syndrome

In recent years, reports of repetitive motion injuries have risen dramatically in workplaces across the country. These problems, frequently termed “Cumulative Trauma Disorders” are being reported at alarming rates in all types of workplaces – from meatpacking plants to newspaper pressrooms. According to the Bureau of Labor Statistics, “disorders associated with repeated trauma” account for about 60% of all occupational illnesses. Of all these disorders, carpal tunnel syndrome is the condition most frequently reported.

What is Carpal Tunnel Syndrome (CTS)?

The carpal tunnel receives its name from the 8 bones in the wrist, called carpals, that form a tunnellike structure. The tunnel is filled with flexor tendons which control finger movement. It also provides a pathway for the median nerve to reach sensory cells in the hand. Repetitive flexing and extension of the wrist may cause a thickening of the protective sheaths which surround each of the tendons. The swollen tendon sheaths, or tenosynovitis, apply increased pressure on the median nerve and produce Carpal Tunnel Syndrome (CTS).

What are the Symptoms of CTS?

The symptoms of CTS often first appear as painful tingling in one or both hands during the night, frequently painful enough to disturb sleep. Accompanying this is a feeling of uselessness in the fingers, which are sometimes described as feeling swollen, even though little or no swelling is apparent. As symptoms increase, tingling may develop during the day, commonly in the thumb, index, and ring fingers. A decreased ability and power to squeeze things may follow. In advanced cases, the thenar muscle at the base of the thumb atrophies, and strength is lost.

Many patients with CTS are unable to differentiate hot from cold by touch, and experience an apparent loss of strength in their fingers. They appear clumsy in that they have trouble performing simple tasks such as tying their shoes or picking up small objects.

What Causes CTS— with a BIG BUT…

As stated earlier, swelling of the tendons that line the carpal tunnel causes CTS…. WITH A BIG BUT…

Carpal tunnel syndrome is VERY easily confused with a disc injury at C6, the disc near the bottom of your neck.  That nerve root, versus the median nerve, supplies the same distributional area on the hand.  Doing tests on the neck to rule this out can save a lot of necessary care, and even necessary surgery.

Although there are many reasons for developing this swelling of the tendon, it can result from repetitive and forceful movements of the wrist during work and leisure activities. Research conducted by the National Institute for Occupational Safety and Health (NIOSH) indicates that job tasks involving highly repetitive manual acts, or necessitating wrist bending or other stressful wrist postures, are connected with incidents of CTS or related problems. The use of vibrating tools also may contribute to CTS. Moreover, it is apparent that this hazard is not confined to a single industry or job but occurs in many occupations, especially those in the manufacturing sector. Indeed, jobs involving cutting, small parts assembly, finishing, sewing, and cleaning seem predominantly associated with the syndrome. The factor common in these jobs is the repetitive use of small hand tools. As chiropractors, we have found that impingement ANYWHERE along the course of a the median nerve can cause CTS. Therefore, we always start our evaluation of the neck first, then work down the arm.

How Large a Problem is CTS?

In the past ten years, more and more cases of workers afflicted with CTS have been reported in medical literature. One reason for this increase may be that automation and job specialization have fragmented workers’ tasks to the point where a given job may involve only a few manipulations performed thousands of times per workday. Increased awareness of work-related risk factors in the onset of CTSis reflected in the growing number of requests for health hazard evaluations (HHEs) received by NIOSH to investigate such suspected problems. NIOSH received about three times as many HHE requests related to hand and wrist pain in 1992 as compared to 1982.

Prevention

NIOSH recommendations for controlling carpal tunnel syndrome have focused on ways to relieve awkward wrist positions and repetitive hand movements, and to reduce vibration from hand tools. NIOSH recommends redesigning tools or tool handles to enable the user’s wrist to maintain a more natural position during work. Other recommendations have involved modified layouts of work stations. Still other approaches include altering the existing method for performing the job task, providing more frequent rest breaks, and rotating workers across jobs. As a means of prevention, tool and process redesign are preferable to administrative means such as job rotation.

The frequency and severity of CTS can be minimized through training programs that increase worker awareness of symptoms and prevention methods, and through proper medical management of injured workers.

Treatment

PLEASE- PLEASE – PLEASE– TRY CONSERVATIVE CARE FIRST!!

The treatment idea should work like this: Chiropractic care first, drugs second, and surgery last.

The most brutal medical treatment of CTS may involve surgery to release the compression on the median nerve. The success rate of the surgery really depends on the CAUSE of the problem. Medical doctors always assume the problem is at the wrist… this is not true, and accounts for the huge numbers of failed surgeries. We say failed because 2 plus percent of the people who get the surgery don’t ever get better, with loss of the median nerve. Because 100,000 surgeries are done each year, 2,000 of you are going to have failure. Ouch. It amazing to me how many people would just rather be cut.

Before that I would recommend the use of antiinflammatory drugs and hand splinting to reduce tendon swelling in the carpal tunnel. Such medical interventions have met with mixed success, especially when an affected person must return to the same working conditions.