Carpal Tunnel Syndrome (CTS) is a condition in which a nerve in the wrist gets pinched resulting in numbness, tingling, and sometimes grip strength loss. One of the first symptoms of CTS involves waking up at night due to the numb, tingly sensations. This initially occurs once in a while but eventually becomes more frequent, leading to sleepless nights. Most people do not initially attribute this sleep interruption to CTS but rather report, “…it’s coming from sleeping on my arm or lying in a funny position.” Because restful sleep is a very important health issue, this early CTS symptom should prompt the person to investigate the problem, but usually they wait, sometimes for months or even years, which can make treatment more challenging.
Other symptoms may include waking up in the morning with wrist and/or hand pain, difficulty buttoning a shirt or threading a needle, radiating arm symptoms into the forearm, shoulder and/or neck, dropping silverware, pens, coffee cups, and a specific pattern of numbness such as the index, middle, and part of the ring finger. The degree of functional loss varies from none to total disability — not being able to work or carry out many home activities. Some people notice the symptoms during the day while performing fast, repetitive movements such as playing piano, typing, using a computer mouse, crocheting/knitting, writing, assembly work, etc. Some of the most frustrating complaints from CTS patients include lost work time (due to both CTS symptoms and fatigue from not sleeping at night), a loss in earnings, lack of dexterity (buttons, tying shoes, turning a key in a door or car, fixing hair, applying make-up), daytime grogginess, and irritability that can impact quality of life, including relationships.
A question that often arises is, what is carpal tunnel syndrome? A simple answer is “tendonitis” or inflammation of the tendons that connect the muscles on the palm side of the forearm (flexor muscles) to their respective tendons that attach in the hand and fingers. Digging a little deeper, there are nine of these tendons that travel through the tunnel, rubbing together as we move our fingers and all is usually well unless there is too much friction resulting in swelling in this confined space. In fact, CTS remains silent until the swelling starts and pushes/compresses the median nerve at which point the numbness, tingling, pain, etc., are noticed.
So, the next question is, what can be done to stop the inflammation from compressing the nerve? A very common treatment approach is the use of a cock-up splint at night, which stops one from bending the wrist during sleep. In a normal, non-CTS wrist, the pressure in the carpal tunnel increases two-fold when the wrist is bent; however, if inflammation already exists inside the carpal tunnel, the pressure increases by many multiples. This is why sleep interruption is so common in CTS as one just can’t control their wrist position at night. Another common anti-inflammatory approach is cortisone shots into the carpal tunnel and/or taking an anti-inflammatory drug like ibuprofen. The chiropractic answer to anti-inflammation is ice (preferably ice massage over the palm side wrist) and anti-inflammatory nutrients such as ginger, tumeric, boswellia, and others. What gives chiropractic the “edge” over non-surgical medical care is the addition of joint and soft tissue manipulation of the hand, wrist, forearm, elbow, and when needed, the shoulder and the neck. The latter improves circulation, reduces fixation or adhesion between tissues, and allows the tendons to slide with less friction resulting in better function as noted by longer ability to play piano, type, write, etc.
Another “key” item to CTS treatment is identifying and finding a solution to a poorly designed workstation so the wrist/hand does not have to work in an awkward manner. Here, the position of a computer screen, how a tool is held, and how long repetitive work is allowed are modified.