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.
We all know the most common causes of “whiplash” are injuries that typically arise from automobile accidents or, motor vehicle collisions (MVC’s) although whiplash can also occur from slip and fall and virtually, any injury where your head is whipped backwards. But there are many things about whiplash you may not be aware of, which is the reason for this month’s Heath Update on whiplash.
For example, did you know the effect whiplash has on public health (in general) is tremendous? The number of cases occurring annually is frequently quoted as 1,000,000 per year, but this is based on an outdated (1971) and incomplete dataset. A more recent figure of 3 million per year is considered to be more accurate because it’s based on several governmental databases and it accounts for the expected number of unreported cases by the NHTSA (National Highway Traffic Safety Administration). That’s a huge difference! The updated figure accounts for whiplash victims not attended to by emergency medical services. In less catastrophic accidents, the injured party may not appear to be significantly injured at the scene of the MVC and decline emergency care and hence, the MVC will to unreported to a governmental data collection center.
Video: Whiplash Health Update
Another interesting study surveyed over 3500 chiropractors who were asked if they commonly applied cervical (neck) spinal manipulation to patients who had known herniated discs or protruded discs (in their neck). Over 90% of the chiropractors indicated they found it safe and effective to utilize cervical adjustments (manipulation) in this patient population. It is VERY important for you to know this as frequently, you may be told by your medical doctor (or next door neighbor), “…don’t let anyone crack your neck!” Now, you can rest assured that in the experience of MANY chiropractors (not just me), significant benefits can be achieved by this treatment approach. Moreover, the sooner neck adjustments are applied, the better the results - so don’t wait to get a chiropractic treatment after an MVC!
Another interesting study investigated the “proper” or “best” seated position in a car during a rear-end collision, based on an analysis of many previously published studies on this topic. Because the seated position of the person involved in a MVC is related to the degree of the injury, the factors studied included the angle of the seat back, seat-bottom angle, the density of the foam in the seatback, the height above the floor [of the knees], and the presence of armrests in cars. They found that the seat back angle of 110-130 degrees reduced disc pressure and low back muscle activity but 110 degrees – MAX. – was found to minimize the forward positioning of the head. A 5 degree downwards tilt of the seat bottom further reduced the pressure in the low back discs and muscle activity as measured by an EMG Test (electromyography). The use of armrests and the use of a lumbar support were also found to be important to reduce injuries associated with MVCs. This combination was reported to be optimum for all of us to use in order to minimize the bodily injury in a rear-end MVC. Other important factors included firm dense foam in the seat back, an adjustable seat bottom (for angle, height, and front to back distance), horizontal and vertical lumbar support adjustments (…best if they pulsate to reduce the static load encountered in a crash), seat shock absorbers, and seat adjustments for front to back to adjust for different patient heights.
We hope this information is helpful. We realize you have a choice in where you go for your health care needs. We truly appreciate your consideration in allowing us to help you through this potentially difficult process.
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!).
Have you ever noticed how many people have terrible posture? One of the most common faulty postures is called “forward head carriage” or “anterior based occiput.” Other terms are “hump back” or slouching. There are several reasons for this common postural fault. One is the weight of the head is, on average, approximately 10-13 pounds and if it’s positioned too far forwards, the muscles in the upper back and neck tighten up much more than normal, fatigue and become painful. Also, the muscles that attach to the skull have different degrees of strength. They also attach and pull at different angles, contributing to the common forward head carriage posture. The muscles of the chest are much stronger than those in the mid and upper back and tend to pull our shoulders forward. The following pictures offer a good view of both a faulty posture as well as a “good” posture. Notice the forward shift in the line in the pictures of poor posture and backwards shift in the good posture pictures.
As you can see, the weight of the head is back over the shoulders and the shoulder posture is appropriately positioned back in the image titled “Good Head Posture.”
Forward Head Carriage
Good Head Posture
Forward shoulders
Good Shoulders Posture
It is important to understand correcting Forward Head Carriage takes time – in fact, it takes a minimum of 3 month before this becomes an automatic new “habit.” Of course, it could take longer or, completely fail IF you are not VERY conscientious about CONSTANTLY reminding yourself to position your posture as shown above in the “Good Head Posture” image (above). An exercise based on this posture correction technique is performed by retracting your chin / head as far back as you can and holding that position for 5-10 seconds. Doing this multiple times a day, between the time you maintain a partial chin tuck (“Good Head Posture”) position will further facilitate the posture retraining process.
Dr. Cilea is president of Advanced Wellness, an integrated practice that offers chiropractic care, physical therapy, pain management, acupuncture and massage therapy. To find out if you are a candidate for their customized treatment approach call 732-719-8148 or visit www.advanced-wellness.net.
