What is Carpal Tunnel Syndrome?

Carpal Tunnel Region is in the front (palm side) of the wrist where the median nerve travels through,  surrounded by bones, soft tissue, muscles, and tendons.

Carpal tunnel syndrome (CTS) occurs when the median nerve, which runs from the forearm into the palm, becomes squeezed or pressed at the wrist.  It’s a passageway that is rigid and narrow and made of ligament and bones at the base of the hand—the median nerve and its tendons perform the motion of bending the fingers.  The median nerve also gives sensation and feeling to the palm side of the thumb, part of the ring fingers (not the pinky finger), the index and the middle. It also controls some small muscles at the base of the thumb.

Sometimes, thickening from the lining of irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed.  The result may be numbness, weakness, or sometimes pain in the hand and wrist, or occasionally into the forearm and elbow. The most common entrapment neuropathy is CTS.

Most people that develop Carpal Tunnel Syndrome work with their hands a lot or type at a computer all day. Contractors, Plumbers, Painters, desk workers and yes even Chiropractors are more prone to it. Synergy Wellness Chiropractic and physical therapy in NYC see a lot of carpal tunnel cases due to the advanced FDA approved cold laser technology we use.

What are the typical symptoms of carpal tunnel syndrome (CTS)?

Symptoms typically start with frequent tingling, numbness and pain in the wrist, palm, hand and the fingers, more commonly in the thumb, index and middle fingers. Many that suffer from CTS say their hands feel useless and swollen, even though swelling may not be evident. The symptoms can appear in one or both hands, usually during the night. The hand or wrist can feel numb or painful when you wake up in the morning and usually gets better as the day goes on. In severe cases, you may have pain during the day as well.  In untreated and chronic cases the muscles become atrophied in the palm (thenar) region.

What are the various causes of Carpal tunnel syndrome?

It comes from a multitude of factors reducing the space within the already narrow carpal tunnel region and not usually with the median nerve itself.   Contributing factors include injury or trauma to the wrist, causing fracture, sprain, strain or swelling. Mechanical dysfunction or injury in the wrist joint, excessive work stress, repeated use of vibrating hand tools, or repeated use of hands in general. Some less common causes are an overactive pituitary gland, rheumatoid arthritis or hypothyroid.  Pregnancy or menopause can cause fluid retention during, developing a cyst or tumor in the canal can also contribute to the compression.

How is CTS Diagnosed?

To avoid irreparable damage to the median nerve early diagnosis and treatment is essential.

• A detailed history and medical exam will be done focusing on the neck, shoulders, arms, wrists, and hands because an injury to the neck can mimic the same symptoms you have from CTS.
• Examination of the wrist for discoloration, swelling, warmth, and tenderness.  The hands and fingers should be checked for muscle atrophy, weakness, loss of sensation.
• If there was trauma to the wrist, digital X-ray can tell if there is a fracture or arthritis. Laboratory work can detect diabetes that can damage the nerves.
• Neurological testing with Nerve conduction velocity or Electromyograph studies help determine CTS and the extent of damage to the median nerve. These tests help confirm the diagnosis.
• Orthopedic tests that reproduce the symptoms of CTS like Tinel test or Phalen’s test. These tests take only 1 minute for a Doctor of Chiropractic to check.
• Ultrasound imaging can help show size of the carpal tunnel region and median nerve.
• Magnetic resonance imaging (MRI) of the wrist usually done when there is trauma to the wrist but is not typically used in diagnosing carpal tunnel syndrome.

How is Carpal tunnel syndrome treated?

Underlying causes such as arthritis or diabetes should be treated first.

Treatments for carpal tunnel syndrome should begin as early as possible and under professional guidance.

Non-surgical treatments

• Cold Laser Therapy – BRAND NEW AND NOW FDA APPROVED. The safest, most effective treatment that Synergy Wellness Chiropractic & Physical Therapy of NYC has to offer for carpal tunnel syndrome sufferers.
• Splinting
• Applying ice packs
• Nonsteroidal anti-inflammatory drugs, such as aspirin, Advil or ibuprofen may provide some short-term relief from discomfort but does not treat CTS itself.
• Prednisone or other Corticosteroids like lidocaine that can be injected directly into the wrist, but often it’s a temporary relief.

Surgery  (WE HELP YOU AVOID SURGERY)

If you’ve already had surgery and still having pain, cold laser therapy can be beneficial in breaking up the scar tissue, reducing inflammation and healing and repairing soft tissue damage. It’s the most effective solution for those that have already gone through surgery once or if you are considering it.