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Diagnosis and Treatment of Carpal Tunnel Syndrome

Thumb muscle atrophy from untreated CTS (wikipedia)

Thumb muscle atrophy from untreated CTS (wikipedia)

Carpal Tunnel Syndrome (CTS) is an entrapment neuropathy of the median nerve, which runs from the forearm into the hand. If the median nerve becomes compressed where it runs through the carpal tunnel, pain, weakness, and/or numbness occurs at the hand and wrist.

How Is It Diagnosed?

CTS should be diagnosed and treated early. A standard physical examination of the hands, arms, shoulders, and neck can help determine if your symptoms are related to daily activities or to an underlying disorder.

Your doctor of chiropractic can use other specific tests to try to reproduce the symptoms of carpal tunnel syndrome. The most common are:

  • Pressure-provocative test. A blood pressure cuff placed at the front of the carpal tunnel is inflated (or manual pressure), followed by direct pressure on the median nerve.
  • Carpal compression test. Moderate pressure is applied with both thumbs directly on the carpal tunnel and underlying median nerve at the transverse carpal ligament. The test is relatively new.

Laboratory tests and x-rays can reveal diabetes, arthritis, fractures, and other common causes of wrist and hand pain. Sometimes, those with suspected peripheral nerve disorders are referred for electrodiagnostic tests, such as nerve conduction velocity testing, are used to help confirm the diagnosis. With these tests, small electrodes, placed on your skin, measure the speed at which electrical impulses travel across your wrist. CTS will slow the speed of the impulses and will point your doctor of chiropractic to this diagnosis.

What Is the CTS Treatment?

Initial therapy includes:

  • Resting the affected hand and wrist
  • Avoiding activities that may worsen symptoms
  • Immobilizing the wrist in a splint to avoid further irritation from twisting or bending
  • Applying cool packs to help reduce swelling from inflammations
  • Some medications can help with pain control and inflammation. Studies have shown that vitamin B6 supplements may relieve CTS symptoms.
  • Research has demonstrated how chiropractic joint manipulation and mobilization of the wrist and hand, stretching and strengthening exercises, and soft-tissue mobilization techniques are important treatments for CTS. Scientists are also investigating other therapies, such as acupuncture, that may help prevent and treat this disorder.

Occasionally, patients whose symptoms fail to respond to conservative care may require surgery. The surgeon releases the ligament covering the carpal tunnel. The majority of patients recover completely after treatment, and the recurrence rate is low. Proper posture and movement as instructed by your doctor of chiropractic can help prevent CTS recurrences.

How Can CTS Be Prevented?

Cole Pain Therapy Group recommends the following tips for some work environments:

  • Perform on-the-job conditioning, such as stretching and light exercises.
  • Take frequent micro-breaks.
  • Use fingerless gloves to help keep the hands warm and flexible.
  • Use correct posture and wrist position.
  • To minimize workplace injuries, jobs can be rotated among workers. Employers can also develop programs in ergonomics—the process of adapting workplace conditions and job demands to workers’ physical capabilities.

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