Carpal Tunnel Syndrome: Everything You've Ever Wanted to Know about CTS

Carpal tunnel syndrome (CTS) is a common condition that affects millions of people worldwide. It occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes compressed or squeezed at the wrist. This compression can lead to pain, numbness, and tingling in the hand and arm, making everyday tasks difficult and uncomfortable.

What is Carpal Tunnel Syndrome?

The carpal tunnel is a narrow passageway in the wrist, about an inch wide, that protects the median nerve and tendons that bend the fingers. When tissues surrounding the flexor tendons swell, they put pressure on the median nerve. This pressure can cause numbness, tingling, and eventually hand weakness if left untreated.

Causes and Risk Factors

Several factors can contribute to the development of carpal tunnel syndrome:

1. Repetitive hand movements

   Example: A data entry specialist who types on a keyboard for 8 hours a day, entering information into spreadsheets and databases. The constant, repetitive motion of typing can put stress on the wrists and hands.

2. Awkward hand positions

   Example: A dental hygienist who frequently has to twist and angle their wrist to reach different areas of a patient's mouth while cleaning teeth. These unusual positions can strain the wrist and compress the median nerve.

3. Strong gripping

   Example: A construction worker who uses power tools like jackhammers or drills for extended periods. The forceful grip required to control these tools can put pressure on the carpal tunnel.

4. Mechanical stress on the palm

   Example: A cyclist who rides long distances with their weight leaning on their palms, pressing against the handlebars. This constant pressure on the base of the palm can irritate the median nerve.

5. Vibrational Stress

   Example: A factory worker who operates a vibrating assembly line machine for their entire shift. The continuous vibration can cause inflammation in the wrist, potentially leading to carpal tunnel syndrome.

Can you see how much stress the position of his wrist is creating on his joints? If he does this activity often, the stress on the joints and soft tissue can lead to carpal tunnel syndrome.

Certain health conditions can also increase the risk of developing CTS:

- Diabetes

- Thyroid dysfunction

- High blood pressure

- Autoimmune disorders

- Fractures or trauma to the wrist

Women are three times more likely to develop carpal tunnel syndrome than men, possibly due to having smaller carpal tunnels.

Symptoms of CTS

Common symptoms of carpal tunnel syndrome include:

• Numbness, tingling, or burning sensations in the thumb, index, middle, and ring fingers

• Pain or aching in the fingers, hand, or arm

• Weakness in the hand and difficulty gripping objects

• Occasional shock-like sensations that radiate to the fingers

Many people experience symptoms at night due to sleep positions that flex the wrist.

Symptoms often begin gradually and may come and go. Many times, symptoms are exacerbated and feel worse when doing certain activities.

Activities That Can Worsen CTS

Certain activities can exacerbate carpal tunnel syndrome:

1. Prolonged use of vibrating hand tools

2. Assembly line work requiring repetitive wrist movements

3. Prolonged typing or mouse use

4. Playing musical instruments

5. Cooking and food preparation involving repetitive chopping

6. Needlework or crafting

7. Certain sports like racquet sports or weightlifting

Notice the angle of her wrist while using the knife? Over time improper ergonomics like this can lead to wrist pain and/or CTS.

Jobs Most Likely to Cause Carpal Tunnel Syndrome

Some occupations have a higher risk of developing CTS due to the nature of the work:

1. Assembly line workers

2. Data entry specialists and typists

3. Musicians

4. Carpenters and construction workers

5. Mechanics

6. Cashiers

7. Hairdressers

8. Sewers and tailors

9. Painters

10. Dentists and dental hygienists

The intricate hand work involved in many activities like sewing, knitting, and crocheting can create pain and inflammation in the wrists.

Ergonomic Tips for Prevention

For each high-risk occupation, here are some ergonomic tips to help prevent carpal tunnel syndrome:

1. Assembly line workers:

   - Use ergonomic tools designed to reduce wrist strain

   - Take regular breaks to stretch and rest the hands

   - Rotate tasks to avoid prolonged repetitive movements

2. Data entry specialists and typists:

   - Use an ergonomic keyboard and mouse

   - Maintain proper posture with wrists in a neutral position

   - Take frequent short breaks to stretch

3. Musicians:

   - Practice proper technique and hand positioning

   - Take regular breaks during practice sessions

   - Use supports or braces when needed

4. Carpenters and construction workers:

   - Use power tools with vibration-reducing features

   - Wear anti-vibration gloves

   - Alternate hands when using tools for extended periods

5. Mechanics:

   - Use tools with larger, padded handles to reduce grip force

   - Keep wrists in a neutral position when using tools

   - Use power tools when possible to reduce manual force

6. Cashiers:

   - Adjust the height of the cash register for a neutral wrist position

   - Use both hands to scan items

   - Take micro-breaks to stretch hands and wrists

7. Hairdressers:

   - Use ergonomic scissors and tools

   - Adjust the chair height to maintain a comfortable arm position

   - Take breaks between clients to rest hands

8. Sewers and tailors:

   - Use ergonomic scissors and tools

   - Take frequent breaks to stretch hands and wrists

   - Maintain good posture while working

9. Painters:

   - Use ergonomic paintbrushes and rollers with larger handles

   - Take regular breaks to rest and stretch

   - Alternate hands when possible

10. Dentists and dental hygienists:

    - Use ergonomic instruments with larger handles

    - Take micro-breaks between patients

    - Maintain proper posture and hand positioning

 Many tasks dog groomers do daily - like using clippers - puts stress on the wrists than can worsen over time. This is called a repetitive motion injury. It can lead to CTS.

Many people type with this hand posture. How could this person adjust their wrists to have better ergonomics?

Exercises and Stretches to Help

Regular exercises and stretches can help alleviate symptoms and prevent the progression of carpal tunnel syndrome:

Wrist flexor stretch: Extend your arm with the palm up, then use your other hand to gently bend the wrist down. Hold for 15-30 seconds.

Wrist extensor stretch: Extend your arm with the palm down, then use your other hand to gently bend the wrist down. Hold for 15-30 seconds.

Median nerve glides: Make a fist, then open your hand and extend your fingers and thumb. Repeat 5-10 times.

Tendon glides: Move your fingers through five positions - straight, hook fist, full fist, tabletop, and straight fist. Repeat 10 times.

Wrist circles: Gently rotate your wrists in circles, both clockwise and counterclockwise.

Chiropractic Care for Carpal Tunnel Syndrome

Recent research has shown promising results for chiropractic care in treating carpal tunnel syndrome. Chiropractors use various techniques to address CTS, including:

1. Wrist and arm adjustments

2. Soft tissue mobilization

3. Ultrasound therapy

4. Exercises and stretches

5. Ergonomic advice

A study published in the Journal of Manipulative and Physiological Therapeutics found that chiropractic care improved functional abilities and nerve conduction in CTS patients. The researchers concluded that chiropractic treatment may be effective for CTS, especially when combined with ultrasound therapy and wrist supports.

Another study in the Journal of Chiropractic Medicine reported significant improvements in symptoms and function for CTS patients receiving chiropractic care. The treatment included chiropractic manipulative therapy, soft tissue mobilization, and home exercises.

Chiropractic care is a great first defense against developing carpal tunnel syndrome and a viable conservative care option for the treatment of CTS if symptoms have already started to occur.

When to Consider Surgery

While many cases of carpal tunnel syndrome can be managed with conservative treatments, surgery may be necessary in some situations:

1. Symptoms persist for 6-12 months despite non-surgical treatments

2. Severe pain that interferes with daily activities or sleep

3. Muscle weakness or atrophy in the thumb

4. Loss of sensation or numbness that doesn't improve with treatment

5. Nerve tests show significant median nerve damage

If you experience any of these symptoms, consult with a healthcare professional to discuss treatment options, including the possibility of surgery.

Conclusion

Carpal tunnel syndrome is a common but manageable condition. By understanding the causes, recognizing early symptoms, and implementing preventive measures, many cases can be avoided or effectively treated without surgery. If you experience persistent symptoms, consult with a healthcare professional to determine the best course of treatment for your individual case.

References:

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2. Dale, A. M., Harris-Adamson, C., Rempel, D., Gerr, F., Hegmann, K., Silverstein, B., ... & Evanoff, B. (2013). Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies. Scandinavian journal of work, environment & health, 39(5), 495-505.

3. Moraska, A., Chandler, C., Edmiston-Schaetzel, A., Franklin, G., Calenda, E. L., & Enebo, B. (2008). Comparison of a targeted and general massage protocol on strength, function, and symptoms associated with carpal tunnel syndrome: a randomized pilot study. Journal of alternative and complementary medicine, 14(3), 259-267.

4. Burnham, R. S., Steadward, R. D., & Lehmann, J. F. (1994). Shoulder pain in wheelchair athletes: The role of muscle imbalance. The American journal of sports medicine, 22(3), 328-333.

5. Brantingham, J. W., Cassa, T. K., Bonnefin, D., Jensen, M., Globe, G., Hicks, M., & Korporaal, C. (2013). Manipulative therapy for shoulder pain and disorders: expansion of a systematic review. Journal of manipulative and physiological therapeutics, 36(5), 273-299.

6. Fernández-de-Las-Peñas, C., Ortega-Santiago, R., de la Llave-Rincón, A. I., Martínez-Perez, A., Fahandezh-Saddi Díaz, H., Martínez-Martín, J., ... & Cuadrado, M. L. (2019). Manual therapy versus surgery for carpal tunnel syndrome: 4-year follow-up from a randomized controlled trial. Physical therapy, 99(6), 758-769.​​​​​​​​​​​​​​​​