Finding and fixing Carpal tunnel syndrome

Editor's note: Cody Scharf owns Thrive Spine and Sport, a chiropractic and soft tissue clinic in Cedar Rapids focusing on sport and overuse injuries. Scharf is a graduate of Palmer College of Chiropractic and is certified by Integrative Diagnosis for diagnosis and treatment of soft tissue injuries.

By Cody Scharf, community contributor

Carpal tunnel syndrome, or CTS, is something you probably are familiar with.

Affecting approximately three to six percent of the general population, CTS usually is linked to highly repetitive tasks like heavy manual labor, typing and desk work. Characterized by numbness, tingling or burning sensations in the thumb and fingers, carpal tunnel syndrome is the most common nerve entrapment found in the body.

While there is a lot that we do know about CTS, unfortunately it hasn't made fixing it any easier. Successful conservative treatments of carpal tunnel syndrome have been estimated between 3 and 70 percent. That is quite a wide range of success to say the least.

The problem in successful treatment may lie in the diagnosis.

Most commonly, CTS is characterized as entrapment of the median nerve in the carpal tunnel of the wrist. Oftentimes this is not the case.

The median nerve forms in the axilla (armpit) by joining nerves that originate in the neck. After forming, the median nerve continues its path through the upper arm, into the elbow, through the forearm and finally through the carpal tunnel and into the hand. Along this path, the nerve passes through multiple structures before arriving at the carpal tunnel in the wrist.

When healthy, the nerve glides along other muscles, tendons and other soft tissue structures without problem. With overuse and some other conditions, the nerve can become glued and entrapped by adhesion to these structures. When nerves become entrapped, they cause tingling, burning and numbness. This is where the problem lies in most cases of classic CTS.

While the carpal tunnel gets most of the recognition for this problem, the median nerve can become entrapped anywhere along its path to the wrist and hand. The difficulty with treatment is finding where this entrapment exists.

Therapies like drugs, injections and splinting may offer short-term relief, but do nothing to actually fix the entrapment. The same holds true for stretching and exercise. Surgery always should be a last resort.

In order for resolution of CTS, the nerve must be freed from the entrapment, if present, in the soft tissues of the neck and arm.

Fortunately, there are some at home movements for carpal tunnel to see where the entrapment may exist:

Cervical flexion. To start, stand with your back flat against the wall, including the head. Start by tucking the chin to the neck without moving the head off the wall. Note any symptoms into the neck, shoulders or arms. Next move further into flexion by tucking the chin to the top of the sternum. Inability to tuck the chin to the top of the chest, or symptoms into the shoulder or arm, can be a sign of entrapment in the neck.

Shoulder abduction. Stand upright with the arms along the side. Slowly bring the arms up to the ears by moving the arms in a motion similar to a 'jumping jack.” The upper arm should touch the ear. Anything short of this motion or pain or numbness into the hands may be a sign of entrapment.

Wrist/finger extension. Place the forearm flat along the wall with the elbow 90 degrees to the shoulder. Pull back on the wrist until it is 90 degrees to the forearm. Now, pull back on the fingers. They should be roughly 65 degrees to the wrist. Note symptoms. Any motion short of the noted ranges is positive, along with pain, tingling or burning sensations can be a sign of entrapment in the forearm or wrist.

As mentioned earlier, most conservative treatment fails to diagnose properly, and thus, fails to provide proper treatment to fix carpal tunnel syndrome. Manual therapy has been shown to be effective for treatment of nerve entrapment. Carpal tunnel syndrome is progressive in nature, and ultimately leads to surgery in far too many cases where it could have been prevented.

For those suffering with CTS symptoms it is highly recommended to seek proper treatment as soon as possible.

l For more information, email Scharf at dr.cody@thrivespineandsport.com or visit www.thrivespineandsport.com