Carpal tunnel syndrome affects many people, so chances are you’ve heard of this condition. Unfortunately, though, I find that most people don’t really understand what it is and what can be done to help it. Sadly, this group of people who do not understand what it is, often have been diagnosed with it themselves. In this article I’ll discuss carpal tunnel syndrome and my approach to helping people recover from it.
“Carpal” refers to the bones in the wrist. There are eight small “carpal” bones that lie between the lower forearm and the bones of the hands. Now picture them forming a sort of oval tunnel with the help of other tissues in the wrist. A nerve (called the median nerve) and nine different tendons that are part of the finger and thumb muscles go through the carpal tunnel. Carpal tunnel syndrome occurs when the roof of the tunnel (so to speak) drops or narrows due to muscle or ligament dysfunction resulting in a narrowing inside the tunnel. If this occurs, pressure may be applied against the median nerve and result in weakness and changes in sensation of the hand (particularly the thumb, index, middle and ring finger). Sensations can vary but include, pain, numbness (or no sensation), tingling, burning, and temperature changes. Degenerative changes in the tendon(s) can also cause the median nerve to become compromised. Additionally, swelling can occur in the carpal tunnel, again causing increased pressure on the nerve. Swelling can be the result of a systemic problem like “water retention” and even go as far as hypothyroidism. I find those to be the extremely rare exception though. The National Institution of Neurological Disorders and Stroke say this: “contributing factors include trauma or injury to the wrist that cause swelling, such as sprain or fracture; overactivity of the pituitary gland; hypothyroidism; rheumatoid arthritis; mechanical problems in the wrist joint; work stress; repeated use of vibrating hand tools; fluid retention during pregnancy or menopause; or the development of a cyst or tumor in the canal.”
Typically, this condition is thought to be the result of repetitive use of the hand as in typing, etc.. However, an article on MSNBC had this to say: “A 2001 study by the Mayo Clinic found heavy computer users (up to seven hours a day) had the same rate of carpal tunnel as the general population. Harvard University headlined a 2005 press release “Computer use deleted as carpal tunnel syndrome cause.””
Now I’ll discuss how I treat people with carpal tunnel syndrome. Obviously, (as with most conditions) I’ll start with a head-to-toe evaluation of the patient. This approach can (and often does) uncover other sources of imbalance that may be contributing to carpal tunnel syndrome or symptoms that resemble carpal tunnel syndrome. For example, I always consider it prudent to evaluate the elbow, shoulder, neck, pelvis, and (sometimes) the feet with this. The median nerve travels from the neck, down the arm, and then into the hand. This is is why I evaluate the elbow, shoulder, and neck, which is basically “following” the nerve along it’s path to see if there is a compromise in the nerve between the neck and the wrist. Because of this nerve pathway, a person can have symptoms of carpal tunnel syndrome while the source of the pain is actually coming from somewhere other than the wrist. These are certainly the “failed surgery” cases. As mentioned, I also evaluate the supporting muscles and joints of the pelvis and feet, as they can both be sources of reflexive muscle tension in the neck.
That considered, let me now talk more about particulars focusing on treatment to the actual wrist. One very important muscle attaches to the bones of the forearm, the radius and ulna, just above the wrist. This muscle, the pronator quadratus, acts to essentially turn the palm downward, in addition to holding the radius and ulna firmly together. So, it serves to keep the ends of the radius and ulna from “separating”. Now imagine that the ends of those bones are “widened”. This would essentially “flatten out” that area and possibly cause a “stretching” of the tissues just before the “entrance” to the carpal tunnel. Picture a rubber band glued to two pencils while allowing for the rubber band to maintain a ring-like shape. Now, if you pull the pencils away from one another, that ring will become compromised and “flatten out”. Very often the pronator quadratus is inhibited in its function usually from repetitive stress and micro-trauma. As a result, this can cause the muscle to lose its tone and function, thus compromising the wrist. Treatment would be directed to restoring normal muscle function and perhaps doing very simple rehabilitation to regain any lost strength. By the way, ligament laxity (usually from adrenal stress) in the wrist can also cause a problem similar to that of a dysfunctional pronator quadratus.
Next, the carpal bones can get “jammed” (or lose proper mobility) potentially causing undue tension on the median nerve and tendons that pass through the tunnel. This aberration cannot be overlooked in my opinion, because any tension on the tendons can cause them to hypertrophy (or get larger) and often compromise the median nerve due to pressure. A simple, painless chiropractic adjustment can “fix” this.
Also, cold laser therapy directed at the carpal tunnel can often be helpful in eliminating very stubborn conditions. There really is not much more to say about treatment directed at the wrist. It is very straight forward. By the way, I almost always have to look to the elbow and neck to “fix” dysfunction there that usually contributes significantly.
From a “chemical” standpoint, vitamin B6 is almost considered “the” carpal tunnel nutrient because of its “anti-swelling/fluid balancing” effect. Many studies have shown that is has helped, though I can’t say I’ve found it very useful. I usually opt for nutrients that may help nerve damage, like Omega 3 and 6 essential fatty acids, and antioxidants. Also, collagen-building nutrients can be helpful in cases where there is damage to connective tissue(s).
In conclusion, don’t forget that it might be a good idea to get a second opinion if the only treatment you’ve been offered is surgery. And, in my experience and opinion, anything can cause anything and perhaps result in symptoms of carpal tunnel syndrome. I have yet to see a case of carpal tunnel syndrome that does not respond favorably to conservative care.
Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology