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