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

Health Update: Carpal Tunnel

Do I Have to Have Surgery For Carpal Tunnel Syndrome?

“For the last few months, I’ve been waking up at night with numbness and tingling in my hand.  Lately, I’ve been waking up more often, 3-4 times a night and I’m having a hard time falling back to sleep.  When I drive, my hands fall asleep within a few minutes and I have to shake my hand and fingers to wake them up. This has gotten to the point where I have to do something but I really don’t want surgery.  What are my non-surgical options?”

CTS or, carpal tunnel syndrome is a condition where a nerve (called the median nerve) that travels down from the neck into the arm and through the wrist becomes pinched and inflamed.  Common symptoms include numbness, tingling, dexterity problems (such as difficulty buttoning shirts), and opening jars due to weakness in grip and pinch strength. Sleep interruptions and loss of many daily activities, including work, occur because of CTS.

There are many non-surgical approaches to the treatment of CTS that should be utilized before surgery is considered, according to the American Academy of Neurology.  In one study, 40% of neurologist polled recommended non-surgical care due to the potential side effects of surgery, some of which being severe, resulting in lengthy work loss post-surgically.  A partial list of non-surgical care options include:

1. Rest – Giving the inflamed CTS time to heal is therapeutic but not always an option.

2. Activity/job modifications – Avoiding certain activities or modifying them by taking breaks during the work day, slowing down the pace of the job, altering the position of the job task, such as propping up a part so that the wrists do not have to bend to the extremes,  or when necessary, complete avoidance of the job task.

3. Wrist Splint – This is a brace that maintains the wrist in a neutral position so it cannot easily bend.  When the wrist flexes or extends, the pressure inside the carpal tunnel (on the palm side of the wrist) increases significantly, placing additional pressure on the already pinched median nerve. Wrist splints are especially useful at night.

4. Nerve Gliding Exercises – These are exercises that stretch the wrist joint and muscle tendons (as well as the median nerve inside the carpal tunnel), with the objective of breaking adhesions that limit the normal glide or movement of the nerve in the forearm and wrist.

5. Manual therapy techniques – These include manipulation of the arm including the forearm, wrist, and hand and sometimes the neck and shoulder, when needed.  The objective is to improve the range of motion of the joints and soft tissues that may be participating in the process of median nerve pinching.

6. Anti-inflammatory medication / nutrients – Medications include aspirin, ibuprofen, naproxen and similar prescription drugs.  Nutritional options including herbs (such as ginger, turmeric, boswellia), digestive enzymes, and Vitamin B6 may also help.  Ice is also anti-inflammatory and direct, on-the-skin ice massage is quite effective.

Chiropractic is a perfect choice when considering a health care provider for the treatment of CTS as many of the above non-surgical techniques are utilized by our office.  We realize that you have a choice in who you are considering 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 CARPAL TUNNEL SYNDROME!  FOR A FREE NO-OBLIGATION CONSULTATION 732-984-9597

Health Update: Carpal Tunnel

Carpal Tunnel Syndrome & Chiropractic

“When I try to thread a needle, button my shirt, or crochet, I can’t seem to feel my finger tips.  I’ve also noticed when unscrewing jars, my grip feels weak.  In fact, I almost dropped a cup of coffee the other day.  I wake up 3-4 times a night and I have to shake my hand and flick my fingers to wake them up.  Gripping the steering wheel is becoming a challenge and I have to change hands frequently while I drive. I’ve had this off and on for the last 5 years but this last year it seems to be getting worse.  I’m really getting concerned.  Can you help me?”

 
If this history sounds familiar, you may be suffering from carpal tunnel syndrome or CTS.  It’s a very common disorder affecting millions each year.  Its also one of the biggest problems for certain types of industries such as meat packaging plants, textile manufacturers, and virtually any job that requires fast, repetitive movements commonly used on assembly lines in many lines of work.

CTS is the result of pinching of the Median Nerve as it travels from the neck into the arm, through muscles in the forearm and into the hand through the carpal tunnel.  Pressure on the nerve at any of these locations can create the symptoms of CTS. This tunnel is quite small in size and included inside the tunnel are 9 tendons, blood vessels, and the median nerve. When the muscles of the forearms and hands are overworked, they inflame and swell.  Because the carpal tunnel is normally so tight, the increased swelling inside the tunnel pushes and pinches the median nerve creating the classic pain, numbness, tingling, and sometimes burning sensations often described by people suffering with CTS.

Certain situations make people more vulnerable or prone to develop CTS.  CTS is more common in woman than men by 3 or 4:1.  This is partially because women’s bone structure is smaller and therefore their Carpal Tunnel is smaller too.

Women also experience fluid retention or build up during menstruation leading to symptoms like swollen fingers and swollen and painful breasts. Swelling in the already tight, confined space of the carpal tunnel will increase their susceptibility for developing CTS.  Another hormone related cause or contributing factor is the use of birth control pills (BCPs).  Since there are many different types of BCPs and each woman is unique and different, finding the BCP with the “right balance” of hormones where the swelling side effect is minimized is very important and should be discussed with the doctor who prescribed the BCPs.

Age (>50 years) is also a risk factor and with our aging work force, this is becoming a big issue.  Other conditions like hypothyroid, diabetes, certain types of arthritis, and hypertension / congestive heart failure where an increase in fluid retention occurs can also increase the chance of developing CTS.  Obviously, occupation type plays an important role as previously mentioned.  Many jobs today require the use of computers and we’re finding the position of the monitor, the keyboard and mouse, are very important.

Conservative management of CTS includes wrist, forearm/elbow, shoulder and neck adjustments, corrective exercises, acupuncture and the use of night splints, and an anti-inflammatory diet. Also, correcting the “ergonomic factors” or, job-related causes is of utmost importance.  This is why a physician who treats all of these areas and has the specialized knowledge about CTS is the perfect choice of health care providers. If you, a friend or family member require care for CTS, we would be honored to render our services.


FOR A FREE NO-OBLIGATION CONSULTATION CALL  732-984-9597 
OR VISIT US AT ADVANCED-WELLNESS.NET

Health Update: Carpal Tunnel

Carpal Tunnel Syndrome (CTS) – It's Rush Hour!

Do you recall the last time you were driving along the highway and suddenly, traffic came to a screeching halt? After sitting in your car, waiting impatiently for any movement, you eventually arrive at the cause of the congestion – 4 lanes of traffic funneled into one lane, due to road construction. The fact it’s rush hour makes the whole issue more understandable but not less frustrating. On your next trip through the construction zone, you make sure to avoid rush hour and you fly through without hesitation – because its 2pm rather than 5pm.

So what does this have to do with CTS? This analogy depicts what essentially happens when CTS occurs. Picture an assembly line worker packaging cookies. The cookies come out of the oven 6 rows deep at a rapid pace. There are normally 6 people working the line, 3 on each side, but for the last two weeks, one of the workers has been out on maternity leave and no one was assigned to that position… leaving 5 workers doing the work 6 people usually share. Let’s say, conservatively, there are 25 cookies packaged per minute. In 60-minutes, 1500 cookies (25x60) are packaged; in an 8 hour day 12,000 cookies are packed, and in a 40 hour work week, 48,000 cookies are packaged (by each worker)! That’s a lot of fast, repetitive movements requiring bending forward and reaching, gripping, and moving the cookies into a tray and then stacking the trays.

If there are workers absent or the employer decides to speed up the line and force overtime, most of the workers will reach their limit and hurt. Especially those with other problems that make them more susceptible to CTS like low thyroid function, diabetes, obesity, age over 50, inflammatory arthritis, when taking birth control pills…..you get the picture!. Hence, when working too fast, just like when there are too many cars on the road during rush hour, the fast paced work inflames the tendons in the carpal tunnel and pinches the nerve. This creates pain and numbness/tingling that either slows the worker down or completely forces him/her to have to take time off from the job. When working at a slower, more comfortable pace, there is less friction between the carpal tunnel tendons and, therefore, no or significantly less nerve compression and CTS signs or symptoms, just like driving through the construction site without slowing down when avoiding rush hour.

Why is this? CTS occurs frequently in people who perform fast, repetitive hand movements like our cookie factory worker. That’s because there are 9 tendons attaching the muscles located in the upper forearm (on the palm side) to the fingers in the hand. These tendons travel very close together, especially as they pass through the carpal tunnel of the wrist. These tendons allow us to pick things up (grip and pinch), shake hands, hold babies delicately and function normally in our daily activities. As these 9 tendons pass through this tight tunnel, when it’s “rush hour” or, when fast, repetitive work is occurring, these 9 tendons rub together and they heat up, swell and the pressure inside the tunnel increases. Because the nerve (median nerve) passes through the same tunnel, as the tendons swell, the nerve is pinched or pressed up against the border of the tunnel and numbness / tingling occurs into the palm and fingers 2-4. We find ourselves dropping things, having a hard time buttoning clothes, threading a needle, opening jars, holding onto a steering wheel, and frequently, we wake up at night needing to shake and flick our fingers to “…wake them up.”

Because these symptoms gradually appear, we usually don’t run to our doctor until several months (and sometimes years) after the symptoms have been present. This makes it more challenging to treat CTS and all patients with these symptoms are encouraged to seek treatment as soon as problems start. There are frequently other problems in the neck, shoulder, and elbow because we tend to compensate, move differently and use other muscles when there is pain so the elbow, shoulder and neck become involved and require attention. This is why a chiropractor who treats all of these areas is the perfect choice. 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 (CTS) – Can It Be Prevented?

Carpal Tunnel Syndrome or CTS is a very common problem affecting many workers and is one of the most costly conditions afflicting today’s workforce.  It is most often caused by repetitive activity using rapid movements of the arms and hands and can lead to work loss and disability when not properly managed.  CTS occurs when the median nerve that travels through the carpal tunnel (CT) located on the palm side of the wrist becomes pinched by the swelling of the 9 tendons that also travel through the CT and essentially, pinch the nerve up against the transverse carpal ligament.  This results in numbness, tingling and/or pain of the index, middle and forth fingers.

Other symptoms include sleep interruptions where shaking and flicking of the fingers is required to allow for a return to sleep.  This is frequently caused by sleeping with the wrist in a cocked position, increasing the pressure inside the already swollen carpal tunnel.  This is why a cock-up wrist splint usually helps as it disallows the wrist from bending to the extremes and the nerve is not pressured or pinched as much.  Other symptoms include weakness of the grip, making it a challenge to unscrew a jar, open a door, and even sometimes turn the key when starting a car.  Driving can also be affected as the hands often fall asleep while holding onto a steering wheel.

Pain can also affect the rest of the arm and sometimes the neck area.  The median nerve can also be pinched in more than one place and may include the neck, shoulder, elbow as well as the wrist making it necessary to have all the areas treated for a satisfying result.

People at greatest risk are women > men, workers who handle small tools, computer workers, fast repetitive line workers, and people older than 40 years of age.  People with other health conditions including rheumatoid arthritis, Lymes disease, rubella, pregnancy, birth control pill use, diabetes mellitus and menopause are at an increased risk of developing CTS.  Certain foods such as caffeine, tobacco, and/or alcohol may also contribute to CTS.

Though treatment is very important –the sooner the better- prevention is most important.  In fact, some simple approaches can make a big difference!  Some of these include modifying the position of a computer chair, keyboard, monitor, or mouse (work station modifications), alternate between different tasks to reduce the repetition of work, stretch your forearms and fingers before, during and after work, and treat any underlying conditions.  When symptoms first occur, these recommendations, as well as wearing a night wrist cock-up splint and seeing your chiropractor, will often reverse the condition without difficulty.  If you wait too long and nerve damage occurs, it becomes a more challenging process to manage CTS and at times, even surgery will not be very helpful.

Some of the non-surgical treatment approaches you might expect from your chiropractor include joint manipulation and/or mobilization applied to the neck, wrist, elbow and/or shoulder, the application of physical therapy modalities such as ultrasound, electrical stim, and/or low level laser therapy (“light” therapy), as well as the use of wrist splints.

The University of Maryland Medical Center cites two research articles on chiropractic treatment for CTS. They report good results are usually obtained and that these good results continued for at least 6 months after treatment ended.  The same reference also recommends nutrition and supplements in the management of CTS.  Some of these include: eliminate food allergens (often milk, cheese, eggs, ice cream, glutens/wheat-grains, soy, corn, and preservatives) and eating foods high in B-vitamins (dark leafy greens like spinach, kale, and sea vegetables), anti-oxidants (fruits – blueberries, cherries, tomatoes; vegetables – squash, bell peppers),  avoiding refined foods, using olive oil and adding omega 3 fatty acids to the diet (fish oil).  Other vitamins including a multivitamin, B complex, Vit. C, alpha-lipoic acid, MSM, resveratrol, Vit. D, Co-Q10, magnesium can also really help.

We realize that you have a choice in where you choose for your healthcare services.  If you, a friend or family member requires care for CTS, chiropractic care is a logical first choice and we would be honored to offer our services to you.

 YOU MAY BE A CANDIDATE FOR OUR CARPAL TUNNEL SYNDROME PROGRAM
 FOR A FREE NO-OBLIGATION CONSULTATION CALL 732-984-9597