Carpal Tunnel Syndrome

( CTS )

Carpal tunnel syndrome ( CTS ) is an entrapment ( pinching or compression ) of the median nerve in the carpal tunnel ( between the bones ) of the wrist. When this entrapment occurs the patient with CTS will often experience numbness, tingling or even slight pain on the palmar surface of the hand.¹ This pain typically occurs at night and awakens the patient with numbness -caused by flexing of the wrist during sleeping- , causing the patient to seek various positions including hanging the hand over the edge of the bed, shaking the hand and other methods to relieve the numbness. With progression the pain may occur during daytime and become constant.² Aching pain may radiate to the elbow and shoulder¹. The typical pattern of the pain involves the index, middle, the half of the ring finger toward the middle finger and the thumb. In later stages CTS may include wasting of the thenar eminence ( the muscles at the base of the thumb ).³This condition is commonly brought on by occupational overuse of the wrist in which the wrist is either held in or moved into the flexed ( bent toward the palm ) position. A common problem is the use of vibratory hand tools which repeatedly abuse the hand and wrist.⁴ Trauma from a wrist fracture ( Colle's fracture ). True CTS seldom involves both hands, except during pregnancy, and very seldom extends beyond the level of the wrist.

People at risk for CTS include bakers, professional drivers, secretaries, weight lifters, diabetics, menopause, hypothyroidism³ and in others who must forcibly flex their wrist repetitively for long periods of time. Secretaries who keyboard are often at risk since the angle of the keyboard is not ergonomically correct.⁵ Pregnancy can often cause CTS as edema and swelling in the wrist occur.

Medical intervention for CTS most often involves Carpal Tunnel Release Surgery. Although these surgeries are about 90% successful⁶,they often heal slowly and almost all show fibrotic or keloid formation². The added advantage of carpal tunnel release surgery is that of decreased overall costs by lowering productivity and wage reimbursement losses for workers compensation claims.^7,8

Chiropractic and non-surgical intervention for CTS can involve the use of non-steroidal anti-inflammatory drugs (NSAIDs ) such as ibuprofen, and immobilization of the wrist by splinting during rest. Also your Chiropractor can adjust and massage the wrist and carpal tunnel to slightly increase the dimension within the carpal tunnel and increase the mobility of the carpal joints. Your Chiropractor may also prescribe pyridoxine ( vitamin B6 ) which has been shown to be somewhat effective in reducing the edema of CTS.^9,10 The best outcomes, however, are attained by early diagnosis and occupational modifications to prevent further damage to the carpal tunnel and its contained structures.

Caution: even though vitamin B6 is a natural and necessary nutrient, its consumption must be monitored for toxic conditions such as sensory nerve loss, sleepiness and other toxic conditions. You should not take excess vitamin B6 or any other drug without the supervision of a licensed physician who can monitor you for the various side effects. If you are pregnant, consult your obstetrician before taking any medication. Please read the warning on page two.

Note: the use of birth control pills can interfere with the absorption of vitamin B6.

For further research check out the Health-Gate-Free-Medline link.

For more information on the benefits of Chiropractic care see the American Chiropractic Association Homepage.

Bibliography

1. Peripheral Entrapment Neuropathies , 2^nd ed; Kopell Harvey P, M.D.; Thompson Walter A L, M.D.; Robert E Kreigler Publishing Co. Inc, Fl,1987; ISBN 0-88275-214-6

2. The Upper Extremity In Sports Medicine, 2^nd ed; Nicholas James A, M.D.; Hershman Elliot B, M.D.; Posner Martin A, M.D., Ed of Hand Section; Mosby-Year Book Inc, 1990; ISBN 0-8151-6392-4

3. Sports Injury Assessment & Rehabilitation; Reid David C, M.D.; Churchill Livingstone, N.Y., 1992;

ISBN 0-443-08662-1

4. Occupation and Carpal Tunnel Syndrome [published erratum appears in Med J Aust 1994 Dec 5-19; 161 (11-12) see comments]; Cullum DE; Molloy CJ; Med J Aust, 161:9, 1994 Nov 7, 552-4

5. Wrist Posture While Keyboarding: Effects of a Negative Slope Keyboard System and Full Motion Forearm Supports; Hedge A; Powers JR, Ergonomics,38:3,1995 Mar,508-17

6. Carpal Tunnel Syndrome: Update; Rankin EA; Pankin EA Jr; J Natl Med Assoc, 87:3, 1995 Mar, 193-4

7. Social and Economic Costs of Carpal Tunnel Surgery; Palmar DH; Hanrahan LP; Instr Course Lect, 44, 1995, 167-72

8. Carpal Tunnel Syndrome; Sipos DA; Orthop Nurs,14:1, 1995 Jan-Feb, 17-20

9. Myofascial Pain and Dysfunction: The Trigger Point Manual: The Upper Extremity; Travell Janet G, M.D., Simons David G, M.D.; Wilkins & Wilkins, 1993; ISBN 0-683-08366-X

10. Carpal Tunnel Syndrome During Pregnancy: Prevalence and Blood Level of Pyridoxine; Atisook R; Benjapibalm M; Susaneevithayakul P; Roongisuthipong A; J Med Assoc Thai, 78:8, 1995 Aug, 410-4