Mississauga Chiropractor Presents: Carpal Tunnel Syndrome

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Here’s another blog from a Mississagua Chiropractor…

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Carpal Tunnel Syndrome is the compression of the median nerve where the nerve passes through the carpal canal deep to the transverse carpal ligament along with the finger flexor tendons.

 

Gender:  Females > Males (5:1); most commonly in middle aged women

Age:  Most common in 40-60 year old (but can occur at any age)

 

Overuse/Ergonomic Stressors:

  • Repetitive finger or wrist flexion/extension, ulnar deviation motions
  • Constant pressure over the carpal tunnel (bandages, casts, watches, bracelets)
  • Trades (mechanics, carpenters, meat packers, butchers, typing, computers, cashiers)
  • Vibration (jack hammer, truck driver), vibratory power tools
  • Repetitive fine hand movements (seamstress, writers, beauticians, typing), chiropractors, dentists, dental hygenists, athletes (gymnastics, weight lifting, cycling), housewives, musicians
  • Gripping (tradesmen, rock climbers)

 

History:

 

Patient will note intermittent “pins & needles” in the thumb, index & middle finger, but not usually over the palm of the hand; also will note anterior wrist pain

  1. If the numbness is over the palm, it may signify compression of the median nerve near the elbow (pronator teres) or higher (brachial plexus or nerve root)
  2. If the numbness is over the hypothenar, digits 4 & 5, it may signify compression of the ulnar nerve (ulnar tunnel, ulnar groove at elbow, brachial plexus or nerve root)

 

Signs & Symptoms:

  1. Decreased light touch & sharp-dull sensations in the median nerve distribution
  2. Decreased hand grip

 

Management:

  1. Rest
  • Avoid repetitive ulnar deviation, finger extension/flexion & wrist flexion/extension
  • Avoid prolonged static wrist flexion/extension, vibratory tools, prolonged/repetitive gripping
  • Wrist supports (usually best in neutral functional position; posterior splint

2.  Osseous mobilization of the wrist, carpals, elbows, shoulders

3.  Massage Therapy:

  • Treat the pronators/elbow flexors
  • Deep tissue massage/Active Release Technique (ART) of the anterior forearm, neck, scalenes, protator teres

4.  Ice packs when condition is acute.  If ice is aggravating the symptoms, switch to heat

  • Alternate hot/cold when the condition is chronic
  • Hot packs, then stretch pronators/forearm flexors & ice after

5.  Electrotherapy  – Discontinue of signs and symptoms increase

  • Ultrasound: anterior forearm & wrist
  • TENS/forearm (over pronator) or wrist (over median nerve)
  • IFC:  Distal forearm & anterior/posterior hand

6.  Exercise Therapy

  • Warm-up by stretching the neck, shoulder, elbow, wrist, hand, fingers
  • Median nerve flossing; Ulnar nerve flossing
  • Daily intermittent stretching every hour for 1-5 minutes
  • Later on – active grip exercises (clay, silly putty, racket ball)
  • Strengthen pronators, wrist flexors, wrist extensors
  • Discontinue if any of the above exercises aggravates the symptoms and reintroduce at a later time.

7.  Ergonomics & Patient Education

  • 90 degrees Rule for the whole body when in a sitting desk work position; avoid sustained or repetitive extension/flexion/ulnar deviation
  • Straight wrist, thinner or split keyboard
  • Desk top support
  • Good sitting/standing/sleeping posture
  • Proper grip size/padded grip/padded glove

 

Prognosis:

  • Conservative care is an excellent initial treatment care option
  • Patients over 50 years old, chronicity over 10 months, constant numbness, atrophy over the thenar eminence are often less responsive to conservative care
  • Refer for surgical consultation if treatment failure or severe acute presentation

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