Diagnosis and Treatment of Carpal Tunnel Syndrome

Diagnosis and treatment of carpal tunnel syndrome based on visual inspection

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.  Diagnosis and treatment of carpal tunnel syndrome is critical, since long term compression causes further damage. Carpal tunnel syndrome is the most common type of nerve entrapment in the body. 

Diagnosis of carpal tunnel syndrome

The diagnosis and treatment of carpal tunnel syndrome should happen early in the process to prevent a permanent loss of nerve function. A careful physical examination of the hands, arms, shoulders, and neck aids your doctor in an accurate diagnosis. Hand symptoms can occur from problems at the spine, shoulder, elbow, or wrist.

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.

Furthermore, 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 benefit from special electrodiagnostic tests.  Nerve conduction velocity tests are helpful to confirm a carpal tunnel 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.

Treatment of carpal tunnel syndrome

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, especially during the night
  • Applying cool packs to help reduce swelling from inflammations
  • Therapeutic ultrasound
  • 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 for nerve disorders.

Occasionally, patients whose symptoms fail to respond to chiropractic care may require surgery. The surgeon releases the ligament covering the carpal tunnel. A 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 recurrence.

Prevention of CTS

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 correct workplace 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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