Carpal tunnel syndrome (CTS) is the most expensive of all work- related injuries.
Over his or her lifetime, a carpal tunnel patient loses about $30,000 in medical bills
and time absent from work. In 1998, an estimated 3 of every 10,000 workers took
time off from work because of CTS. Half of them missed more than IO workdays.
CTS typically occurs in adults, with women 3 times more likely to develop it than
men. The dominant hand is usually affected first, and the pain is typically severe.
CTS is especially common in assembly- line workers in manufacturing, sewing,
finishing, cleaning, meat packing, and similar industries. Contrary to the conventional
wisdom, according to recent research, people who perform data entry at a
computer (up to 7 hours a day) are not at increased risk of developing CTS.
What Is CTS?
CTS is a problem of the median nerve, which runs from the forearm into the hand.
The median nerve provides sensation to the palm side of the thumb, index, and
middle fingers and regulates the function of some small muscles in the hand that
move the fingers and thumb. CTS occurs when the median nerve gets compressed
in the carpal tunnel-a narrow tunnel at the wrist-made up of bones and soft tissues,
such as nerves, tendons, ligaments, and blood vessels. The compression may result
in pain, weakness, and/or numbness in the hand and wrist, which radiates up into the forearm. CTS is the most common of the "entrapment neuropathies"-compression
or trauma of the body's nerves in the hands or feet. A similar condition in the foot is
called tarsal tunnel syndrome.
What Are the Symptoms?
Symptoms usually begin gradually. Burning, tingling, itching, and/ or numbness in the
palm of the hand and thumb, index, and middle fingers are most common. Some
people with CTS say that their fingers feel useless and swollen, even though little or no swelling is apparent. Since many people sleep with flexed wrists, the symptoms often
first appear while sleeping. When this happens, some people feel the need to "shake
off the numbness." As symptoms worsen, they may feel tingling during the day. In
addition, weakened grip strength may make it difficult to form a fist, grasp small
objects, or perform other manual tasks. Some people develop wasting of the muscles
at the base of the thumb. Some are unable to distinguish hot from cold by touch.
Why Does CTS Develop?
Some people have smaller carpal tunnels than others, which makes the median nerve compression more likely. In others, CTS can develop because of an injury to the
wrist that causes swelling, over- activity of the pituitary gland, hypothyroidism,
diabetes, inflammatory arthritis, mechanical problems in the wrist joint, poor work ergonomics, repeated use of vibrating hand tools, and fluid retention during pregnancy
or menopause. In some cases, no cause can be identified.
How Is It Diagnosed?
To avoid permanent damage to the median nerve, CTS should be diagnosed and
treated early. A standard physical examination of the hands, arms, shoulders, and
neck can help determine if your symptoms are related to daily activities or to an
underlying disorder. Your doctor of chiropractic can use other specific tests to try to produce the symptoms of carpal tunnel syndrome. The most common are:
* Pressure-provocative test. A cuff placed at the front of the carpal tunnel is inflated, followed by direct pressure on the median nerve.
* Carpal compression test. Moderate pressure is applied with both thumbs directly
on the carpal tunnel and underlying median nerve at the transverse carpal ligament.
The test is relatively new.
Laboratory tests and x-rays can reveal diabetes, arthritis, fractures, and other
common causes of wrist and hand pain. Sometimes electrodiagnostic tests, such as
nerve conduction velocity testing, are used to help confirm the diagnosis. With these
tests, small electrodes, placed on your skin, measure the speed at which electrical
impulses travel across your wrist. CTS will slow the speed of the impulses and will
point your doctor of chiropractic to this diagnosis. These tests can also help determine
if some other condition is causing your complaints.
What Is the CTS Treatment?
CTS treatment should begin as early as possible under a doctor's supervision. Initial
* Resting the affected hand and wrist
* Avoiding activities that may worsen symptoms
* Immobilizing the wrist in a splint to avoid further damage from twisting or bending
* Applying cool packs to help reduce swelling from inflammations.
Some medications can help with pain control and inflammation. Studies have shown that vitamin Ek supplements may relieve CTS symptoms.
Chiropractic joint manipulation and mobilization of the wrist and hand, stretching
and strengthening exercises, soft-tissue mobilization techniques, and even yoga can
be helpful. Scientists are also investigating other therapies, such as acupuncture, that
may help prevent and treat this disorder. Your doctor of chiropractic can discuss
those therapies with you and help you prevent the return of CTS.
Occasionally, patients whose symptoms fail to respond to conservative care may
require surgery. The surgeon releases the ligament covering the carpal tunnel. Today,
this outpatient procedure is typically done with an endoscope-a camera that the
surgeon uses to see inside the carpal tunnel. The majority of patients recover
completely after treatment, and the recurrence rate is low. Proper posture and
movement as instructed by your doctor of chiropractic can help prevent CTS
How Can CTS Be Prevented?
The American Chiropractic Association recommends the following tips:
* Perform on-the-job conditioning, such as stretching and light exercises.
* Take frequent rest breaks.
* Wear splints to help keep the wrists straight.
* Use fingerless gloves to help keep the hands warm and flexible.
* Use correct posture and wrist position. If needed, your doctor of chiropractic
can assess your work situation and advise you on restructuring your workstation,
job tasks, and handling tools or tool handles, to help you position your wrists
naturally during work.
* Your doctor of chiropractic can help educate your employer about CTS. To
minimize workplace injuries, jobs can be rotated among workers. Employers can
also develop programs in ergonomics-the process of adapting workplace conditions
and job demands to workers' physical capabilities.
Your doctor of chiropractic has the knowledge, training, and expertise to help you understand what your problem is and, in many cases, manage it successfully.
Remember, however, that the treatment program can be successful only with your
active participation. If your doctor of chiropractic feels that he or she cannot help
you, he or she will direct you to another health care provider.
It is not uncommon for pregnant women to suffer the effects of carpal tunnel
syndrome. This is due to the hormonal changes and increased edema (fluid) in the extremities. Subluxation plays a major role in the formation of carpal tunnel in
ICA International Review of Chiropractic, Jan./Feb. 1993
Since 1985, when the U. S. Occupational Safety and Health Administration
(OSHA) accepted that there were "traumatogens" in the workplace and demanded
that repetitive motion disorders be reported, the recorded incidence of cumulative
trauma disorders has skyrocketed (Figure 3). About 277,000 cases were reported
in 1997, compared with fewer than 50,000 in 1985. CTS has been the fastest
growing category, recently accounting for more than 40% of all work-related
disabilities. An estimated 26,000 CTS patients in the United States undergo surgical decompression each year. Median time lost from work is about 32 days per
patient, more than for any other cause, including back pain.
Source: US Department of Labor
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