Health Update: Carpal Tunnel

Musicians and
Carpal Tunnel Syndrome

Dart Fine-Art

  
  There are many jobs that place people at risk for carpal tunnel syndrome (CTS), but I bet you wouldn’t have thought of musicians.  First and most important, I don’t want to scare anyone from playing a musical instrument as many of us find music to be a very important “release mechanism” or, an escape from reality (at least for a while) in our busy lives. Playing music uses part of the brain that doesn’t get enough stimulation and has been found to improve learning skills in children and can improve (as well as prevent) Alzheimer’s Disease in the more mature sector of the population. So PLEASE, continue playing your instrument or if you don’t play, start taking lessons on your favorite instrument – something an increasing number of adults are beginning to do!

Ok, now that the “disclaimer” is over, we can discuss why musicians are at risk for developing CTS and how you and I can prevent CTS from becoming a “monster!” Playing a musical instrument utilizes our fingers in a rapid, repetitive way, similar to a typist or keyboard worker. Also, some instruments require the hands and wrists to be placed in awkward positions, which is bad because the tendons, as they rub against each other inside the tunnel, create friction, heat and swell up, thus pinching the median nerve. If the wrist is bent, the pressure inside the carpal tunnel goes up a lot more than when it’s kept straight, and this is especially true if there are already problems present like a mild case of CTS. In brief , the anatomy of the carpal tunnel includes 9 tendons, some blood vessels, and the median nerve which are, in a sense, jammed into a tight, confined space. Think of pulling a napkin through a napkin ring that is just a little bit too small – you REALLY have to work to pull the napkin through, right?  Well, this is kind of what happens when one develops CTS. Instead of having a napkin and ring that match so the napkin easily pulls through, those with CTS have a tight, constricted tunnel (napkin ring) which really squeezes the contents, including the median nerve.  The result of pinching a nerve is numbness, tingling, burning, and/or a “half-asleep” feeling in fingers 2, 3, and 4 (that is, the index, middle and ring fingers).

When you watch a piano player, their palms are pointing down towards the floor while they play.  The two long bones in the forearm, the ulna and radius, are parallel when the palms are up and cross over one another when the palms are down. The median nerve travels down from the neck, axilla, upper and lower arm and finally through the carpal tunnel to innervate the middle three fingers.  There is more pressure on the median nerve when the palms are pointing down compared to up, but it would be impossible to play the piano palms up!  Other instruments like the flute, trombone, trumpet, and many others require the arms and hands to be raised up to around the head level while the instrument is played.  This places more pressure on the median nerve in the axilla area, referred to as the thoracic outlet. Many musicians practice multiple hours a day and the repetitive motion can really irritate the median nerve, and can result in CTS.

Again, please understand we are not inferring for you to stop playing your musical instrument! Rather, take multiple breaks when practicing, do carpal tunnel stretch exercises, and seek chiropractic care as we can usually manage CTS successfully without the need for surgery.

We realize you have a choice in who you choose for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend or family member require care for CTS, we would be honored to render our services

Health Update: Carpal Tunnel

Carpal Tunnel Syndrome:
Why Braces?

For those of you who have had Carpal Tunnel Syndrome, you probably know all about braces. These are devices worn on the wrist that stop you from bending the wrist up or down. They may be worn anytime of the day if they don’t interfere too much with one’s current activity but are especially worn at night. One might think it would be more important to wear these during day when we are active and moving our fingers and hands a lot as we go about our normal work or play activities – not at night when we’re basically just laying there doing nothing but sleeping, right? Wrong! It’s more important to wear these at night. This is because we cannot control our hand/wrist position at night as we tend to curl up in a ball when we sleep and the wrist gets cocked up or down, often to the end point of the range. So, why is this so bad? To answer that question, let’s look at the chart below on the left.

      

In the chart (above left), you are looking at a cross section of the wrist through the carpal tunnel. This illustrates the many structures that are inside the tunnel making it very compact or tight. Notice the small white circles in the middle of the tunnel. Those are the tendons that pass through the tunnel – there are 9 of those and they attach the muscles in our forearms (on the palm side) to our fingers so we can shake someone’s hand or carry a suitcase (grip). Just to the left of center, on top of all the tendons sits the median nerve, which is just below the “roof” of the tunnel (the transverse carpal ligament). Now, normally, the pressure inside the carpal tunnel will approximately double when we bend our wrist, putting more pressure on the nerve and pushing it into the roof (ligament), which creates the numbness and/or weakness in our grip. But in the CTS sufferer, there is already more pressure in the tunnel due to the swollen tendons so when the wrist is flexed or extended, the pressure goes up much more the twice – more like 6 times more pressure – hence, more symptoms. So, if we’re sleeping with our wrist bent either way, the pressure pushing the nerve against the roof is a lot more than normal – 6x more! Now, can you see the reason for the “night splint?” It is VERY effective in keeping the wrist straight or “in a neutral position,” which is needed to allow the nerve to NOT be pinched so it can heal.

Video: Carpal Tunnel Syndrome

Regarding braces, there are MANY different kinds of braces available and deciding which one to use is no easy task, not to mention the fact that they come in different sizes! When you are treated for CTS at this office, we will fit you with the proper size brace, if it’s necessary. We realize you have a choice in health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend or family member require care for CTS, we would be honored to render our services.

We hope this information is useful to you or someone you care about. For more information, visit us at www.newjerseypainmanagement.net or call us directly 732.719.8148 for a free consultation.

Health Update: Carpal Tunnel

Carpal Tunnel Syndrome
Why is it so common?

Carpal tunnel syndrome or, CTS, is a condition where a nerve (called the median nerve) is compressed in a relatively tight or restricted space (called the carpal tunnel), resulting in altered nerve function that includes numbness and weakness. In order to fully understand what CTS is, let’s devote this Health Update to better understanding the anatomy of the carpal tunnel.

Video: Carpal Tunnel Syndrome

 

The carpal tunnel is made up from 8 bones (2 rows of 4 carpal bones that are stacked on top of each other) that are arranged in the shape of a horse shoe. The “roof” of the tunnel is a ligament (transverse carpal ligament) that stretches tightly across the two ends of the horseshoe completing the formation of a tunnel – actually, an upside down tunnel when looking at the palm side of the wrist). The contents of the tunnel include 9 tendons and their covering (sheath), blood vessels and on top of all that just under the roof is the median nerve – the culprit that creates most of the symptoms of CTS. The cause of CTS is simply anything that causes the contents inside the tunnel to swell, which then compresses the median nerve up into the roof or ligament, pinching the nerve. This can create numbness, tingling, the falling asleep sensation and weakness. It’s important to point out that the median nerve starts out from the neck, passes through the shoulder, past the elbow, through the wrist’s carpal tunnel and ends in the hand – specifically fingers 2,3, and 4. Therefore, the ENTIRE nerve must be looked at for all CTS cases as pinching can occur anywhere along its course from the neck to the hand.

It’s said that pictures say a thousand words, so let’s take a look...

               

Using the pictures here, familiarize yourself with the words and re-read the 2nd paragraph above, periodically looking at these pictures until you feel you understand where everything goes.  Once you’ve accomplished that, you’ll be able to better appreciate CTS, how the anatomy relates to the condition, and appreciate the need to reduce the swelling inside the tunnel when symptoms occur.  The treatment is simple: “PRICE” – P protect R rest I ice C compress E elevate – accomplished by bracing (especially at night), ice cup massage (5 min. until numb 5x/day), rest (light duty work), and therapy (see your chiropractor!).

To find out if you are a candidate for their customized treatment approach call 732.719.8148 or visit us at www.advanced-wellness.net or www.newjerseypainmanagement.net

Health Update: Carpal Tunnel

Exercises For Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a common condition resulting in hand and sometimes neck and arm complaints. This can include numbness or tingling in the fingers, leading to dexterity problems such as difficulty buttoning clothing or picking up small objects. There are also issues with strength loss / weakness noticed such as when turning door knobs, opening jars, and even problems with turning the key to start a car. One big problem with CTS is people often wait too long before having it treated thinking it will “…go away” or disappear just like it started. CTS rarely gets better without some form of treatment and seeing a chiropractor makes perfect sense prior to considering surgical intervention.

So, the question remains, “what can I do for CTS?” There are several things a CTS sufferer can do to help manage this condition. Some risk factors such as gender and age cannot be changed but other factors can be changed including taking “mini-breaks” throughout the work day and/or work station modifications, managing weight as obesity (defined as a BMI >30 and a waist size >35” for women and >40” for men), wearing a wrist splint, as well as performing exercises to stretch the wrist area.

A study out of the University of Oklahoma reported 2 out of 3 patients with mild to moderate CTS avoided surgery by performing specific exercises. The concept of a 5-minute warm-up stretch each day before starting the workday is similar to a runner stretching before a run to prevent injury.

Step A: Extend and stretch both wrists and fingers acutely as if they

are in a standing push-up position. Hold for a count of 5.

Step B: Straighten both wrists and relax fingers.

Step C: Make a tight fist with both hands.

Step D: Then, bend both wrists down while keeping the fist. Hold for a

count of 5.

Step E: Straighten both wrists and relax fingers, for a count of 5.

Step F: Then, let your arms hang loosely at the side and shake them

for a few seconds.

This exercise should be repeated 10 times and can be repeated several times a day.

Chiropractic is a perfect choice when considering a health care provider for the treatment of CTS as these exercises can easily be taught to you at our office. In addition, many other non-surgical treatment options for CTS are available.

We realize you have a choice in who you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend or family member require care for CTS, we would be honored to render our services.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR FIBROMYALGIA! FOR A FREE NO-OBLIGATION CONSULTATION CALL (732) 719-8148