According to the American Chiropractic Association, 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.

CTS typically occurs in adults, with women three 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, meatpacking and similar industries. Contrary to the conventional wisdom, according to recent research, people who perform data entry at a computer (up to seven 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. CTS occurs when the median nerve gets compressed in the carpal tunnel (a narrow tunnel at the wrist) comprised 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. The carpal bones form the “roof” of this tunnel, and any downward misalignment or collapse of these bones significantly compromises the opening of the tunnel and therefore irritates the nerve passing through it.

What are the symptoms?

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. As symptoms worsen, they may feel tingling during the day. In addition, weakened grip strength may make it difficult to form a fist or grasp small objects. 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?

We all have carpal tunnels, but 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.

How is it diagnosed?

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 Multicare doctor 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 this same wrist and hand pain. Sometimes electrodiagnostic tests, such as nerveconduction 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.

What does CTS treatment at home look like?

Resting the affected hand and wrist and avoiding activities that may worsen symptoms is always recommended. Immobilizing the wrist in a splint to avoid further damage from twisting or bending and applying cool packs to help reduce swelling and inflammation is also helpful. Even some medications can help with pain control and inflammation. Studies have shown that vitamin B6 supplements may even relieve CTS symptoms.

What does effective CTS nonsurgical treatment look like?

If resting does not help or is not an option, the initial treatment option should always be a conservative approach first. Soft tissue techniques performed by a physical therapy team should be performed first to loosen up the wrist and get it ready for the chiropractic mobilization and realignment of the wrist bones which are obstructing this tunnel and its nerve. Concurrent medical physician management is helpful to offer a proper CTS diagnosis and prescribe anti-inflammatories if necessary to gain as good of a recovery as possible. After successful realignment and pain relief have been achieved, a customized stretching exercise routine should be instructed to prevent a return of symptoms. Treatment of this type has been proven effective and is one more reason why Multicare Physicians Group has combined all of these provider types under one roof.

Early detection is the key. If the patient’s condition is deemed severe, he/she very well may not respond to conservative management and may require surgery. Instead of simply realigning the wrist bones to create a larger tunnel for the nerve, the surgeon must cut the ligament covering the carpal tunnel. You can always go to a surgical extreme, so get evaluated first and see if conservative management with less adverse risks is available first.

For more information or to make an appointment, call Multicare Physicians Group at (712) 276-4325.

Multicare Physicians Group is located at 3930 Stadium Drive in Sioux City.

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