All posts in Elbow & Wrist

Repetitive Strain Injuries

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REPETITIVE STRAIN INJURIES

As your workload at the office increases, so do repetitive actions, such as typing, using your computer mouse and talking on the phone. These routine tasks seem simple, but they can add a level of physical stress to the emotional and mental stress of getting the job done. In fact, repetitive strain injuries have skyrocketed in the last 20 years due to the increasing reliance on workplace technology.

Try these tips to reduce the strain:

Computer Monitor

Position your computer screen directly in front of you. Allow the muscles in your eyes to relax by following the 20/20/20 rule: Take a 20-second break every 20 minutes and focus on an object that is at least 20 feet away from you.

Telephone

Use your hand to support the telephone against your ear and alternate sides regularly. Do not cradle the phone between your ear and your shoulder. Consider using a headset or speaker.

Chair

Sit upright and all the way to the back. Place a support cushion or roll against the arch of your low back for lumbar spine support. Here are some tips to help you adjust your chair:

  • Stand in front of the chair and adjust the height so that the highest point of the seat is just below your knee.
  • Sit on the chair and make sure that your knees are bent at approximately a 90-degree angle when your feet are flat on the floor.
  • Adjust the backrest forwards and backwards as well as up and down until it fits the hollow in your lower back.
  • Sit upright with your arms hanging by your sides. Bend your elbows at about a right angle and adjust the armrest height until they barely touch the undersides of the elbows. Remove the armrest from the chair if the right level cannot be achieved.

Lastly, don’t forget to take a quick stretch break or change position every 30 to 45 minutes. Your back, neck and shoulders will thank you for it!

Provided by Dr. Luciano Di Loreto, HBSc., D.C. & Associates

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Dr. Luciano Di Loreto graduated from the Canadian Memorial Chiropractic College (2010) as a Doctor of Chiropractic and obtained a certificate in Medical Acupuncture at McMaster University (2010). At his practice located in Vaughan, Ontario, Canada, Dr. Luciano Di Loreto combines evidence-based chiropractic care with a multidisciplinary and collaborative approach to health care. He is an approachable, passionate, and diligent practitioner with a focus on delivering exceptional acute, preventative, rehabilitative and supportive care for a variety conditions relating to the muscle, nerve, and bone. During his spare time, Dr. Luciano Di Loreto takes pleasure in spending time with his family and friends. He enjoys fishing and playing sports.

Fit for Life Wellness & Rehabilitation Centre is a health clinic located in Vaughan, Ontario, just north of Major Mackenzie on Weston Road (Located in the Vellore Medical Centre & Walk In Clinic at 10395 Weston Road, Unit A., Woodbridge Ontario L4H 3T4). If you have questions for Dr. Luciano Di Loreto & Associates, please comment or email us and we will get right back to you promptly with information on your conditions/concerns.

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Preventing Tennis Elbow, Shoulder Tendinitis and Shin Splint

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HOW TO PREVENT THREE COMMON MUSCLE INJURIES

Playing sports, sitting at a desk all day, or even running outside are all simple actions performed in our day-to-day lives. But, did you know that most of these actions require repetitive movement that can often cause muscle strain. The motions of everyday activities can sometimes contribute to common injuries, such as tennis elbow, shoulder tendonitis and shin splints.

Here are three types of preventative exercises you can do at home to help alleviate and prevent those everyday injuries from slowing you down:

  1. Tennis Elbow, a common overuse injury that happens in the summer months due to increased sports activity with racquet sports, cycling, or golf.
    Preventative exercise: Eccentric strengthening. Use weights to strengthen the area and muscles used in your favourite activities.
  2. Shoulder Tendonitis, a common injury often due to faulty shoulder mechanics that can be a result of sitting disease.
    Preventative exercise: Chest stretches. Chest stretches helps get the shoulders back into the right position. Shoulder blade exercises are also a great way to help mobilize the muscles around your shoulder blades and strengthen the muscles of the mid-back.
  3. Shin Splints, a common injury as people increase their mileage outdoors. It is caused by running on concrete or other hard surfaces for longer periods of time.
    Preventative exercise: Leg stretches. Use a foam roller to warm up your calf muscles and lower leg muscles prior to running.

Being mobile and staying active is a great way to keep fit and healthy. Remembering these simple preventative exercises will help you stay on an injury-free path.

Provided by Dr. Luciano Di Loreto, HBSc., D.C. & Associates

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Dr. Luciano Di Loreto graduated from the Canadian Memorial Chiropractic College (2010) as a Doctor of Chiropractic and obtained a certificate in Medical Acupuncture at McMaster University (2010). At his practice located in Vaughan, Ontario, Canada, Dr. Luciano Di Loreto combines evidence-based chiropractic care with a multidisciplinary and collaborative approach to health care. He is an approachable, passionate, and diligent practitioner with a focus on delivering exceptional acute, preventative, rehabilitative and supportive care for a variety conditions relating to the muscle, nerve, and bone. During his spare time, Dr. Luciano Di Loreto takes pleasure in spending time with his family and friends. He enjoys fishing and playing sports.

Fit for Life Wellness & Rehabilitation Centre is a health clinic located in Vaughan, Ontario, just north of Major Mackenzie on Weston Road (Located in the Vellore Medical Centre & Walk In Clinic at 10395 Weston Road, Unit A., Woodbridge Ontario L4H 3T4). If you have questions for Dr. Luciano Di Loreto & Associates, please comment or email us and we will get right back to you promptly with information on your conditions/concerns.

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Back of my elbow pain…Is this Olecranon Bursitis?

Back of my elbow pain…Is this Olecranon Bursitis?
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What is Olecranon Bursitis?

A 35 year old carpenter came to our clinic complaining that the back of his elbow was swollen and very tender/painful after banging it on a kitchen cabinet during installation. After conducting a health history and detailed physical examination, we determined that this was a case of olecranon bursitis.

What causes Olecranon Bursitis?

A fall, hit, bang or blow to the back of the elbow, repeated weight bearing, improper exercise technique or dragging of the elbow to the ground may cause swelling, inflammation, pain and pooling of edema in the elbow bursa thus causing olecranon bursiitis.

Think of it this way…subdivision and cities often have areas where water collects and distributes during flooding, heavy rainfall or snow melt.  When heavy rain covers our streets it collects in a city catch basin.  The bursa is the elbow’s catch basin for when inflammation, edema or swelling occurs.  It, the bursa, fills up and allows our body to slowly take it away through the lymphatic system and out of our bodies through urine/excretion (similar to a sewage system which ends up distributing the water into larger areas of water outside of the city/subdivision).  

What are Signs and Symptoms of Olecranon Bursitis?

Olecranon bursitis is the size of a goose egg.  The olecranon is the surface of bone at the end of the ulna bone (elbow). It is very difficult to miss since it looks abnormal and may present with redness and feel tender to the touch. It must be differentiated from gout and/or kidney failure which present similarly in the elbow and other joints. Infection is another condition to rule out – however, it typically occurs near an open wound.

How do I treat olecranon bursitis?

At our clinic we treat olecranon bursitis with support tape, along with ice therapy, ultrasound therapy, laser therapy and advice about what activities to avoid. If the bursa is infected, we refer out for aspiration or antibiotic therapy. Our chiropractic and physiotherapy team, reviews the area and assesses the range of motion of the elbow before determining which treatment could be most effective.

Dr. Luciano Di Loreto, HBSc., D.C. & Associates

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Dr. Luciano Di Loreto graduated from the Canadian Memorial Chiropractic College (2010) as a Doctor of Chiropractic and obtained a certificate in Medical Acupuncture at McMaster University (2010). At his practice located in Vaughan, Ontario, Canada, Dr. Luciano Di Loreto combines evidence-based chiropractic care with a multidisciplinary and collaborative approach to health care. He is an approachable, passionate, and diligent practitioner with a focus on delivering exceptional acute, preventative, rehabilitative and supportive care for a variety conditions relating to the muscle, nerve, and bone. During his spare time, Dr. Luciano Di Loreto takes pleasure in spending time with his family and friends. He enjoys fishing and playing sports.

Fit for Life Wellness & Rehabilitation Centre is a health clinic located in Vaughan, Ontario, just north of Major Mackenzie on Weston Road (Located in the Vellore Medical Centre & Walk In Clinic at 10395 Weston Road, Unit A., Woodbridge Ontario L4H 3T4). If you have questions for Dr. Luciano Di Loreto & Associates, please comment or email us and we will get right back to you promptly with information on your conditions/concerns.

 

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Chiropractic & You!

Chiropractic & You!
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Chiropractic health care

The word “chiropractic” comes from ancient Greek and means “done by hand.”

Adjustment of the joints of the body has been used in the healing arts for many centuries and is at the heart of modern chiropractic care.

Chiropractors are specialists in manual adjustment of the vertebrae of the spine and other joints of the body. Adjustment helps relieve pain and restore normal functioning to the joints and supporting muscles and ligaments – so you can enjoy your everyday activities again as quickly as possible.

Your chiropractor will recommend a course of treatment specific to you that may also include mobilization of the joints, ultrasound, muscle release techniques, muscle stimulation and therapeutic exercises.  Chiropractors are also trained to provide nutritional counselling, and recommend rehabilitation and injury prevention strategies.

Back health is important

The body’s information highway – your nervous system – is protected by the spine. The nervous system travels out between the vertebrae or joints of the spine to carry messages from the brain to every corner of your body. Stress and strain on the vertebrae can put pressure on the nerves in the affected area. That is why a problem with your spine can have far-reaching effects causing symptoms such as arm or leg pain.

When to consider chiropractic care

If aching joints and muscle pain are affecting your ability to get through the day and keeping you away from your favourite activities, consider chiropractic care.  Work, accidents, sports injuries, household chores, even the stress of daily living can cause painful joint and back problems. Even if you do not have painful symptoms, chiropractic care can help you maintain healthy spine and joint function.

Here are some of the most common reasons why more than 4 million Canadians visit a chiropractor each year:

  • Back pain
  • Neck pain
  • Headache
  • Whiplash
  • Strains and sprains from daily activities
  • Repetitive strain injuries
  • Work and sports-related injuries
  • Arthritis
  • Restricted movement in the back, shoulders, neck or limbs

Benefits of chiropractic care

Chiropractic treatment is skilled, hands-on health care that relieves pain and helps your body be its best. Here are some of the ways it can help you.

  • Improved movement in your neck, shoulders, back and torso
  • Better posture
  • Relief from headaches, neck and back pain
  • Prevention of work-related muscle and joint injuries
  • Enhanced athletic performance
  • Improved flexibility
  • Relief of pregnancy-related back ache
  • Correction of gait and foot problems

For videos about your first visit and chiropractic adjustments, please visit the following links:

First visit: http://www.chiropracticcanada.ca/en-us/about-chiropractic/chiropractic-and-you/first-visit-video.aspx

Chiropractic adjustments: http://www.chiropracticcanada.ca/en-us/about-chiropractic/chiropractic-and-you/chiropractic-adjustment-video.aspx

Dr. Wendy Mok, HBSC., D.C.

Chiropractor & Acupuncture Provider

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Tennis Elbow vs. Golfers Elbow

Tennis Elbow vs. Golfers Elbow
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Let’s first start with a few Case Studies:

1) 45 Year Old Female

Pain on the outside of the elbow due to twisting/closing jam jars over the weekend.  Pain is localized to the outside of the elbow.  Patient is complaining of progressive pain.

2) 50 Year Old Male

Pain on the inside of the elbow after playing a bocce (lawn bowling).  Patient explains that extending the wrist is painful.  Patient finds it difficult to use his wrist due to the progressive pain found along the inside of his elbow.

Answers found below.

Many patients have been presenting and asking me about these two conditions (tennis elbow and golfers elbow) and how they differ.   Okay, so let us break them down into very simple terms.

1) Both conditions occur at the elbow.

2) Tennis Elbow occurs on the outside of the elbow.

3) Golfers Elbow occurs on the inside of the elbow.

Now that we have these simple concepts in place, let us explore the anatomy of the elbow joint and structures surrounding the joint.

Anatomy of the Elbow

The human elbow consists of 3 bones and 3 articulations. The three bones are the humerus (arm bone), ulna and radius (forearm bones – remember the radius is on the thumb side and the ulna is  on the 5th finger side WHEN the hand is in a position where the palm is facing upwards).   The humerus attaches to the ulna – the humeroulnar articulation and the humeroradial articulation (the articulation between the humerus and the radius).  The third is a pivot-type joint with articulation between the head of the radius and the radial notch of the ulna (the two forearm bones).  Surrounding these joints are a number of muscles, ligaments, fascia and arteries/nerves.  The muscles of the forearm are responsible for turning the arm as if you are using a screw driver as well as flexing/extending the wrist.

Elbow Joint

Elbow Joint

What is Tennis Elbow?

Tennis elbow also known as lateral epicondylitis is a condition that affects the muscle on the outside of the elbow.

Tennis elbow is a painful condition of the elbow caused by overuse or repetitive strain (partial tearing of muscle fibers in the elbow) .  Playing tennis or other racquet sports can cause this condition.  However, it is also important to note that other sports like golf, or activities that involve moving your wrists/elbow joint can aggravate the elbow (Golfers, baseball players, bowlers, gardeners or landscapers, house or office cleaners (because of vacuuming, sweeping, and scrubbing), carpenters, mechanics, and assembly line workers).

Symptoms of tennis elbow include:

  • Pain slowly increasing around the outside of the elbow.
  • Pain is worse when shaking hands or squeezing objects (flexion of the wrist).
  • Pain is made worse by stabilizing or moving the wrist with force.
  • Examples which aggravate pain include lifting, using tools, opening jars, or even handling simple utensils such as a knife, fork or toothbrush.

Tennis elbow affects 1% to 3% of the population.  Interestingly, less than 5% of all tennis elbow diagnoses are related to actually playing tennis!!! Tennis elbow affects men more than women. It most often affects people between the ages of 30 and 50.

What is Golfer’s Elbow?

Golfer’s elbow also known as medial epicondylitis causes pain and inflammation in the tendons that connect the forearm to the elbow. The pain is on the inside aspect of the elbow (area the rests beside the torso when your arms are down).

Golfer’s elbow is caused by overusing or straining the muscles in the forearm that allow you to do the following motions – grip, rotate your arm, and flex your wrist. Continuous or repetitive flexing, gripping, or swinging can cause pulls or tiny tears in the tendons.

This condition doesn’t just affect golfers. Those who do activities with repetitive hand, wrist, or forearm motions can lead to golfer’s elbow.  Furthermore, sports include tennis, bowling, and baseball can cause the same symptoms.

Tennis and Golfer’s Elbow are not that different!

Yes, Tennis and Golfer’s elbow are not that different.  In other words, they are very similar types of strains or tendon aggravation (tendonosis) conditions.   One occurs on the inside of the elbow (golfer’s elbow) and the other on the outside of the elbow (tennis elbow).

SO now that I understand the difference, how to I treat these conditions? Golfer's Elbow Support

At our clinic, we provide patients with a variety of both active and passive treatments.  Passively, chiropractic care, acupuncture, soft tissue therapy, mobilizations, electrotherapy, ultrasound and laser therapy are effective.  Actively, eccentric elbow exercises work well.  An exercise is eccentric when a muscle contraction lengthens the muscle, rather than shortens it. The opposite is called concentric exercises.

Furthermore, some individuals do well with golf and tennis elbow supports.  These are fairly inexpensive and assist with controlling some of the discomfort experienced at the elbow (see image to the right).

Back to the Case Studies

1) 45 Year Old Female

Pain on the outside area of the elbow.  Patient was closing a number of jam jars over the weekend.  Pain is becoming progressively worse.  No shooting pain down the arm, only localized pain in the elbow.  What can it be?

Yes, this is a case of TENNIS ELBOW!

-Pain localized to the outside area of the elbow and mechanism of injury is closing jam jars (twisting wrist and using the extensor muscles in the forearm).

2) 50 Year Old Male

Pain on the inside of the elbow after playing a bocce (lawn bowling).  Patient explains that extending the wrist is painful.  Patient finds it difficult to use his wrist due to the progressive pain found along the inside of his elbow.

-Pain localized to the inside area of the elbow and mechanism of injury is using the flexors of

YES, this is a case of GOLFERS ELBOW! Tennis Elbow

MEDICAL DISCLAIMER: The following information is my personal notes about this subject matter. It is intended for informational purposes only. Consult a health practitioner to help you diagnose and treat injuries of any kind.

Dr. Luciano Di Loreto, HBSc., DC

Chiropractor in Woodbridge, Ontario

www.fitforlifewellnessclinic.com

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Dr. Luciano Di Loreto graduated from the Canadian Memorial Chiropractic College (2010) as a Doctor of Chiropractic and obtained a certificate in Medical Acupuncture at McMaster University (2010). At his practice located in Vaughan, Ontario, Canada, Dr. Luciano Di Loreto combines evidence-based chiropractic care with a multidisciplinary and collaborative approach to health care. He is an approachable, passionate, and diligent practitioner with a focus on delivering exceptional acute, preventative, rehabilitative and supportive care for a variety conditions relating to the muscle, nerve, and bone. During his spare time, Dr. Luciano Di Loreto takes pleasure in spending time with his family and friends. He enjoys fishing and playing sports.

Fit for Life Wellness & Rehabilitation Centre is a health clinic located in Vaughan, Woodbridge, Ontario, just north of Major Mackenzie on Weston Road (Located in the Vellore Medical Centre & Walk In Clinic). If you have questions for Dr. Luciano Di Loreto, please comment and we will get right back to you promptly with information on your conditions/concerns.

10395 Weston Road, Building A

Woodbridge, Ont

L4H-3T4

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Mouse Hand and Wrist Pain…Yes, it exists! How to avoid mouse hand and wrist pain…

Mouse Hand and Wrist Pain…Yes, it exists! How to avoid mouse hand and wrist pain…
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Okay…so what the heck is mouse hand?  Yes, I know it sounds ridiculous! Mouse Hand. My wife was mentioning that she heard this term ‘mouse hand’ from some colleagues.  These colleagues were complaining that their wrists and hands were hurting from typing reports all weekend.   They said that they had mouse hand. I did some background research on this topic and did not find much written on the slang term “mouse hand” solely.

What is MOUSE HAND in medical terms? 

Well, simply put, mouse hand is a repetitive strain injury to the wrist/hand area.  In the case of mouse hand, the wrist and hand becomes strained/sprained when using a mouse for lengthy periods of time.  They also complained of tightness, stiffness, decreased wrist range of motion as well as swelling at times.  I would imagine that individuals who are constantly using a computer with a mouse (bloggers, computer technicians, web designers, etc.), would experience this type of condition.     It is amazing that as our world changes and as it becomes more technologically advanced (2oth and 21st century changes), new musculoskeletal medical conditions come about.  As our job tasks change, so do our injuries and how these injuries may come about.   For instance, let us talk about the chauffeur fracture.  The name originates from early chauffeurs who sustained these injuries when the car back-fired while the chauffeur was hand-cranking to start the car. The back-fire forced the crank backward into the chauffeur’s palm and produced the characteristic styloid fracture (forearm fracture).  It is also known as a backfire fracture (for the same reason) or a Hutchinson fracture. Today, this fracture occurs, however not due to cranking cars.  Instead, it can occur if someone falls on an outstretched hand. Let us get back to Mouse Hand.

I have found a couple of threads on the topic of mouse hand and noticed that some individuals have found ways to prevent and overcome these symptoms of mouse hand (pain, tightness, decreased range of motion and discomfort in the wrist/hand) by simply switching over to using an IPAD or device that does not require the use of a mouse or constant use of their wrist.  Others mentioned doing hand/wrist exercises or taking frequent breaks during long periods of computer/mouse usage.  These techniques both make a lot of sense to me. Mouse Hand is in medical terms a repetitive strain/sprain injury, overuse syndrome, or carpal dysfunction. What is this, you ask?  Well, our wrists consist of 8 carpal bones.  Sometimes these little 8 bones move out of position slightly, spraining the ligaments that attach one carpal to the other.  If this occurs, this causes pain, stiffness and decreased motion in the wrist – dysfunction.   Many patients present with these symptoms – they may not call it mouse hand but they realize that they have injured their wrist.

What happens to the soft tissues in the forearm?

In order to function properly, muscles (and other tissues of the body) require oxygen, which is carried by blood. When muscles are overused or overworked, which may be the result of over-training or performing repetitive motions, blood supply to muscles is reduced (tight muscles squeeze blood vessels thus decreasing flow). This places the muscle in what is called a hypoxic state. Simply stated, the oxygen supply required by the muscle to function is not being met due to decrease in available blood. This leads to the muscle not having the ability to form energy, remove metabolic wastes, etc. Your body, in an attempt to help itself then begins to replace muscle, a very oxygen-needy tissue, with scar tissue, which does not require oxygen to function. This scar tissue binds up and ties down tissues that need to move freely. As scar tissue builds up, muscles become shorter and weaker, tension on tendons causes tendonitis/tendonosis, and nerves can become trapped. This can cause reduced range of motion, loss of strength, and pain. If a nerve is trapped you may also feel tingling, numbness, and weakness.

I find that patients who present with these wrist symptoms (as long as there is no fracture) do well with wrist adjustments, mobilizations and soft tissue therapy to the forearm and wrist.  What do you mean by adjustments and mobilizations?  An adjustment and mobilization is essentially performed to move the carpals back into place or to get them properly moving again – to eliminate dysfunction.   Soft tissue therapy is great to relieve the tight muscles in the surrounding area.   Furthermore, wrist exercises work well to get those carpal bones moving again.  Squeezing a squishy ball or putting an elastic around your fingers and opening your hand works both the flexors/extensors of the forearm.

I hope you enjoyed this blog today.  Please provide feedback and comments.  Thank you.

 

MEDICAL DISCLAIMER: The following information is my personal notes about this subject matter. It is intended for informational purposes only. Consult a health practitioner to help you diagnose and treat injuries of any kind.

 

Dr. Luciano Di Loreto, HBSc., DC

Chiropractor in Woodbridge, Ontario

www.fitforlifewellnessclinic.com

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Dr. Luciano Di Loreto graduated from the Canadian Memorial Chiropractic College (2010) as a Doctor of Chiropractic and obtained a certificate in Medical Acupuncture at McMaster University (2010). At his practice located in Vaughan, Ontario, Canada, Dr. Luciano Di Loreto combines evidence-based chiropractic care with a multidisciplinary and collaborative approach to health care. He is an approachable, passionate, and diligent practitioner with a focus on delivering exceptional acute, preventative, rehabilitative and supportive care for a variety conditions relating to the muscle, nerve, and bone. During his spare time, Dr. Luciano Di Loreto takes pleasure in spending time with his family and friends. He enjoys fishing and playing sports.

Fit for Life Wellness & Rehabilitation Centre is a health clinic located in Vaughan, Ontario, just north of Major Mackenzie on Weston Road (Located in the Vellore Medical Centre & Walk In Clinic). If you have questions for Dr. Luciano Di Loreto, please comment and we will get right back to you promptly with information on your conditions/concerns.

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Part 2 of 2: Is it Carpal Tunnel or Is it Something Else? Median Nerve Entrapment Sites

Part 2 of 2: Is it Carpal Tunnel or Is it Something Else? Median Nerve Entrapment Sites
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In part 1 of 2 of Is it Carpal Tunnel or Is it Something Else?, you were introduced to the common signs and symptoms of carpal tunnel syndrome.  In part 2 of this blog, you will learn about other compression sites and conditions influencing the median nerve, which may resemble the signs an symptoms of carpal tunnel syndrome.  Why is this important, you ask?  First off, if you think you may have carpal tunnel syndrome, you want to be 100% certain.  Second, you don’t want to receive treatment to an area of the forearm that may not be the area or reason for your health problem.

Of course, let’s get started with Forearm Anatomy!

Brachial Plexus 1

Brachial Plexus 1

Nerves of the forearm and hand originate in the neck area off the spinal cord.  The spinal cord (the main cord coming from the brain) breaks down into many smaller branches (roots, trunks, divisions, and cords) of nerves that travel from the neck, through the shoulder, via the arm and down to the wrist and fingers.  Nerves bring the ability to move and feel to our bodies.  Specifically, the MEDIAN NERVE nerve is one of the nerves that provides movement and sensation to the forearm and hand.As you learned in the first blog, nerves can become compressed or squeezed by soft tissue such as muscles and ligaments.  Moreover, compression of a nerve occurs due to various reasons such as sport injuries, repetitive strain/sprain, a tumor (very uncommon), etc.   The nerve involved in carpal tunnel syndrome is the median nerve at the wrist.  As you recall, when this nerve is squeezed around the wrist, a patient may experience frequent burning, tingling, and/or numbness in the palm of the hand and the fingers. Some sufferers say their fingers feel swollen and weak, even though little or no swelling is apparent. The symptoms often first appear in one or both hands during the night. The person may wake up feeling the need to shake out the hand or wrist. Continued carpal tunnel may result in decreased grip strength and muscles wasting at the base of the thumb. Furthermore, some people are unable to tell between hot and cold by touch.

In part 1, we gave the analogy that a traffic jam on a road resembles a compressed nerve.  When a road is blocked with many cars, cars move slower than normal.  A nerve that is squeezed or compressed transmits signals of movement and sensation slower to the hand.  Now, to make things a little more complex, think of a busy highway….throughout the highway you have many areas in which traffic is slower than others.  Let’s call these bottleneck areas. Throughout a stretch of road, there maybe multiple areas of blockages or bottlenecks.  A nerve can also be blocked in various areas in the arm.  Thus, it is important to examine the entire nerve pathway to be sure that no other areas are affected.

Ok, let’s get to the point….

Carpal tunnel syndrome symptoms appears similar to other compression syndromes/sites of the MEDIAN nerve.  There are four regions where this blockage can occur below the shoulder.

1) Supracondylar process of the humerus and struther’s ligament (what a mouth full!):

The median nerve maybe compressed as it passes under a bony spur (normal variant) in the arm.  This would cause weak hand grip, a hard time turning the forearm to a position in which the palm is facing down and it would also create tingling into the 1st to 4th fingers (never the 5th finger).  The presence of having a difficult time turning the forearm into a position in which the palm is facing down is what differentiates this compression problem area from carpal tunnel syndrome.

2) The Lacertus Fibrosus:

The median nerve travels in front of the elbow (palm up side).  The lacertus fibrosus is another area of compression and it is located just before the elbow. One must suspect that the lacertus fibrosis is the problem when pain is experienced in the forearm with resisted elbow flexion.

3) Pronator teres

The pronator teres is located just after the elbow on the palm up side of the forearm.  This area of compression is VERY COMMON and confused many times with carpal tunnel syndrome.  The nerve gets compression as it travels between the two pieces of PRONATOR TERES (Top and Bottom) muscles.  When the muscle is tight and squeezes the median nerve, patients will complain of pain following resisted bending of the the long finger.  Furthermore, the pronator teres muscles will be very tight and tender to touch and may produce symptoms down the forearm when touched.  Usually, patients that do a lot of work with their hands and arms (plumbers, electricians and receptionists) experience this type of compression condition. Increased activity makes this condition worse.  Furthermore, just like the compression areas above, a pronator teres compression will cause tingling to the 1st to 4th finger (palm side).  Pronator teres compression is commonly confused with carpal tunnel syndrome!

4) Anterior Interosseus Nerve (Branch of Median Nerve) 

Brachial Plexus

Brachial Plexus

The Anterior Interosseus Nerve can become compressed in the forearm (palm side up). It is important to note that compression of the median nerve has two presentations.

1) The pronator syndrome in which patients have pain and paresthesias mimicking carpal tunnel syndrome (above),

and

2) the anterior interosseous nerve syndrome in which patients have muscle weakness in there hand (thumb side).

If the Anterior Interosseus Nerve is involved, the patient will not be able to make the ‘OK’ sign with his/her thumb and index finger.  Also, with the forearm flexed, the patient would have difficulty/weakness turning the palm from facing their torso to away from them.

How to you treat a median nerve compression?

Soft tissue therapy, electrotherapy and stretching often helps to relax tight muscle and decompress the tension placed on the nerve.  In my practice, I apply a combination of chiropractic treatment modalities.  I also have found acupuncture to provide pain relief as well periodically decrease the tingling sensations experienced.  Acupuncture also helps by relaxing the tight muscles in the forearm, which is beenficial since it may reduce compression of the nerve.

Conclusion:

Yes, I know, it is overwhelming and sometimes confusing to understand the course of a nerve.  The point I am trying to get across is that the body is tricky and you must not jump to conclusions.  If you or someone you know is experiencing tingling or has a decreased ability to move their forearm or hand, it is not automatically a case of carpal tunnel syndrome.  You must screen whatever nerve is corresponding to the area of interest very carefully.  If you have any questions, please feel free to comment and/or message me.

MEDICAL DISCLAIMER: The following information is my personal notes about this subject matter. It is intended for informational purposes only. Consult a health practitioner to help you diagnose and treat injuries of any kind.

Thank you for reading this post.

Dr. Luciano Di Loreto, HBSc., DC

www.fitforlifewellnessclinic.com

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Dr. Luciano Di Loreto graduated from the Canadian Memorial Chiropractic College (2010) as a Doctor of Chiropractic and obtained a certificate in Medical Acupuncture at McMaster University (2010). At his practice located in Vaughan, Ontario, Canada, Dr. Luciano Di Loreto combines evidence-based chiropractic care with a multidisciplinary and collaborative approach to health care. He is an approachable, passionate, and diligent practitioner with a focus on delivering exceptional acute, preventative, rehabilitative and supportive care for a variety conditions relating to the muscle, nerve, and bone. During his spare time, Dr. Luciano Di Loreto takes pleasure in spending time with his family and friends. He enjoys fishing and playing sports.

Fit for Life Wellness & Rehabilitation Centre is a health clinic located in Vaughan, Ontario, just north of Major Mackenzie on Weston Road (Located in the Vellore Medical Centre & Walk In Clinic). If you have questions for Dr. Luciano Di Loreto, please comment and we will get right back to you promptly with information on your conditions/concerns.

 

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Part 1 of 2: Is it Carpal Tunnel or Is it Something Else?

Part 1 of 2: Is it Carpal Tunnel or Is it Something Else?
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I have a number of patients that mention that they have carpal tunnel syndrome. When I ask them how they know, they can’t explain.  After a history and physical assessment, I often recognize that their symptoms are in fact not related to carpal tunnel. Why the confusion? One thing that I have learned, while practicing, is that tingling in the forearm does not always equate to carpal tunnel syndrome.

In part 1 of this blog, I will provide specific information pertaining only to carpal tunnel syndrome. This will create a firm base for part 2 of the blog – when I explore and explain other nerve conditions which create symptoms similar to carpal tunnel. Let us begin…

What is Carpal Tunnel Syndrome?

Ok, so what is it?  Carpal tunnel syndrome, simply stated, is when a nerve in the forearm is squeezed at the wrist. More specifically, carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes compressed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers (half of the fourth finger and not the little finger). The median nerve also provides motion to small muscles in the hand. The carpal tunnel is a narrow, tight, passageway of ligament and bones at the base of the hand. This tight box is home to the median nerve as well as tendons that attach to muscle and allow our hands to move. Sometimes, the carpal tunnel soft tissues thicken and/or swell. As a result, the tunnel narrows and causes the median nerve to be compressed. This creates pain, weakness, and/or numbness in the hand, wrist and may radiate up the arm.

Let us provide you with an analogy.  Think of when a four lane road merges to become a two lane road.  This creates a bottleneck in the road, which usually leads to heavier traffic due to the less room to manoeuvre.  The more the road reduces, the less the passageway for cars to pass.  Numerous reasons can cause the passageway to shrink (accidents like trauma/injury in a wrist, floods like swelling/inflammation in a wrist and construction like scar tissue/tissue rebuild/healing in a wrist) – the bottom line is that the same amount of cars still need to get through to the other side, but with obstacles or a bottleneck, it becomes harder and thus more issues (symptoms) can arise. This is what occurs when someone has carpal tunnel issues – that is – their passageway for the median nerve is being blocked or squeezed.

Symptoms usually start slow but gradual. Usually, it starts with frequent burning, tingling, and/or numbness in the palm of the hand and the fingers. Some sufferers say their fingers feel swollen and weak, even though little or no swelling is apparent. The symptoms often first appear in one or both hands during the night. The person may wake up feeling the need to shake out the hand or wrist. As symptoms progress, patients complain that they feel tingling during the day. Continued carpal tunnel may result in decreased grip strength and muscles wasting at the base of the thumb. Furthermore, some people are unable to tell between hot and cold by touch.

Causes of Carpal Tunnel Syndrome

Carpal tunnel syndrome is often the result of a combination of factors. These factors are responsible for increasing pressure on the median nerve and tendons in the carpal tunnel. Most likely the disorder is due to genetics. Some individuals are born with a smaller carpal tunnel. Moreover, trauma or injury to the wrist that causes swelling, sprains or fractures, rheumatoid arthritis, mechanical joint issues at the wrist, stress, vibrating hand tools, fluid retention during pregnancy or menopause or the development of a cyst or tumor in the canal. Sometimes no cause(s) are identified.

Who Develops Carpal Tunnel Syndrome

Women are more likely than men to develop carpal tunnel syndrome. Carpal tunnel syndrome usually occurs only in adults and not in children.

How is Carpal Tunnel Syndrome Diagnosed?

There are a variety of tests that are used to produce symptoms of carpal tunnel syndrome.  In the Tinel test, the practitioner taps on or presses the median nerve in the patient’s wrist. The test is positive when tingling in the fingers occurs. The Phalen test, or wrist-flexion, involves having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together (like a reverse prayer sign). The presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, is felt in the fingers within 1 minute.

Diagnosis is confirmed by electrodiagnostic tests such as nerve conduction studies. Often it is necessary to confirm the diagnosis by use of electrodiagnostic tests. In a nerve conduction study, electrodes are placed on the hand and wrist.  Furthermore, ultrasound imaging can show impaired movement of the median nerve and Magnetic resonance imaging (MRI) can show the anatomy of the wrist.

How is Carpal Tunnel Syndrome Conservatively Treated?

Treatments for carpal tunnel syndrome should begin as early as possible. Underlying causes such as diabetes or arthritis should be treated first.

I treat carpal tunnel syndrome by using a variety of chiropractic techniques electrotherapy, ultrasound, laser, cyrotherapy and exercises.  Furthermore, soft tissue therapy techniques over the forearm, wrist and palm of the hand as well as acupuncture are beneficial.  Patients usually feel relief with two to three treatments over the course of 4 to 6 weeks.

Now that you know more about carpal tunnel syndrome…let me explain why people get it confused with other nerve issues located in the forearm.  In part 2 of this blog, I will explore and explain other nerve conditions which create symptoms similar to carpal tunnel.

 

Dr. Luciano Di Loreto, HBSc., DC

www.fitforlifewellnessclinic.com

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Dr. Luciano Di Loreto graduated from the Canadian Memorial Chiropractic College (2010) as a Doctor of Chiropractic and obtained a certificate in Medical Acupuncture at McMaster University (2010). At his practice located in Vaughan, Ontario, Canada, Dr. Luciano Di Loreto combines evidence-based chiropractic care with a multidisciplinary and collaborative approach to health care. He is an approachable, passionate, and diligent practitioner with a focus on delivering exceptional acute, preventative, rehabilitative and supportive care for a variety conditions relating to the muscle, nerve, and bone. During his spare time, Dr. Luciano Di Loreto takes pleasure in spending time with his family and friends. He enjoys fishing and playing sports.

Fit for Life Wellness & Rehabilitation Centre is a health clinic located in Vaughan, Ontario, just north of Major Mackenzie on Weston Road (Located in the Vellore Medical Centre & Walk In Clinic). If you have questions for Dr. Luciano Di Loreto, please comment and we will get right back to you promptly with information on your conditions/concerns.

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