Carpal Tunnel Syndrome and Chiropractic

By
William J. Owens DC, DAAMLP
Mark Studin DC, FASBE (C), DAAPM, DAAMLP

When people experience pain in the wrist, the common assumption is that it is carpal tunnel syndrome. The wrists are made of 2 rows of 4 bones called the carpal bones. When you flip your hand over with the palm facing the sky, there is a covering over those bones at the wrist. To the side of this covering is where you can take your pulse. One of two major nerves that go to the hand travel between this covering and the carpal bones. The nerve travels with the tendons, which connect muscle to bone, of nine muscles that flex the wrist or bring your fingers toward you. The nerve is named the median nerve, so carpal tunnel syndrome is the compression of the median nerve between the carpal bones and the covering of the tunnel at the wrist. This causes numbness and tingling in the thumb, index finger and ˝ of the middle finger because that is where the median nerve goes. Numbness or tingling in any other finger or the palm is not due to carpal tunnel and may be coming from the elbow, shoulder or neck.

There are a few common reasons for carpal tunnel syndrome, the primary one being inflammation or swelling in the tunnel. This can be due to direct trauma like a wrist injury or a result of a car accident involving your hands twisting on the steering wheel. Other causes can be overuse, like typing too much on a keyboard, fine movements at work or weakness and overuse of the forearm muscles. The mild and moderate symptoms can generally be controlled and treated with conservative therapy. More severe cases often require surgery and can only be quantified with a neurological test. Surgery, although necessary in some cases, is a last resort since scar tissue can result from the surgical incision and over time can result in the return of compression of the median nerve in the carpal tunnel. In the cases of the mild or moderate symptoms, they may be due to improper mechanics of the 8 bones of the wrist. In these cases, chiropractic management, using the chiropractic adjustment administered to this area, has been shown to be effective in a recent study.

In this study the authors stated, “From a mechanistic viewpoint, manual therapy techniques designed to release tissue adhesions and increase the range of motion (ROM) of the wrist may alleviate the mechanical compression of the median nerve without the need for surgical interventions"
(Burke et al., 2007, p. 51). They also state, "Interventions were, on average, twice a week for 4 weeks and once a week for 2 additional weeks" (Burke et al., 2007, p. 50). "The improvements detected by our subjective evaluations of the signs and symptoms of CTS and patient satisfaction with the treatment outcomes provided additional evidence for the clinical efficacy of these 2 manual therapies for CTS. The improvements were maintained at 3 months for both treatment interventions” (Burke et al., 2007, p. 50).

The authors related the following statistic, “The American Academy of Neurology and 40% of neurologists in the Netherlands recommend conservative management of CTS before surgical intervention" (Burke et al., 2007, pp. 50-51). An important perspective to have on surgical intervention was also included and the authors stated, “In addition, of patients with failed primary surgical interventions, up to 12% may require a secondary surgical procedure. Persistent symptoms after a secondary surgical procedure ranged from 25% to 95%" (Burke et al., 2007, p. 51). Therefore, we see that the American Academy of Neurology recommends holding off on surgery until other options are explored.

In conclusion, the paper reports, “Although the clinical improvements were not different between the 2 manual therapy techniques, which were compared prospectively, the data substantiated the clinical efficacy of conservative treatment options for mild to moderate CTS"
(Burke et al., 2007, p. 59). In the end, it was the management of carpal tunnel syndrome by a doctor of chiropractic that was the most important factor; the individual techniques did not matter.

If you are experiencing numbness and tingling into hands or fingers, please discuss this with a doctor of chiropractic. Conservative care is recommended by the American Academy of Neurology.



References:


1. Burke, J., Buchberger, D. J., Carey-Loghmani, M. T., Dougherty, P. E., Greco, D. S., & Dishman, J. D. (2007). A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. Journal of Manipulative and Physiological Therapeutics, 30(1), 50-61.

Studin, M. (2009). U.S. Chiropractic Directory. Retrieved From http://www.uschirodirectory.com.