By: Dr. Jennifer N. Milus, DC
Over 100,000 people a year undergo carpal tunnel surgery. What can
we do, conservatively, ourselves, at home or on the course) to
Carpal Tunnel Syndrome CTS) is becoming more and more prevalent with the computer generation, and increased use of small hand held devices. Someone you know has probably suffered from CTS. It is such a common problem; it baffles me that there is so little understanding among the medical community about its causes.
It is linked to several diseases/conditions like: diabetes, gout, thyroid disease, and obesity. It appears to be caused by repetitive motion of the hands, arms and wrist. Many people who have it just happen to do more than one thing that involves heavy use of the area. I have treated a guitar player who rides horses, will stop neither, and getting her better will be difficult. A fire fighter who pulls hose, ropes and dummies and trains with weights is another tough cookie. A golfer who works on the computer at work all day poses the same problems.
Any one of these things done alone, intermittently, will probably not cause a problem. Further: playing golf has not been shown as a direct cause of CTS. But, it could certainly contribute. And the hours a pro plays will absolutely have more effect than the 1-2 rounds a week you or I might play.
So What Happens?
CTS is the result of the compression on the median nerve as it runs through the “tunnel” parallel to the tendons that run the fingers. The wrist bones compress it from one side and a thick ligament can compress it from the other side. Once this area is over used, it becomes enflamed. The mediators of inflammation settle in there, increasing pressure and softening the connective tissue, causing the body to lay down more scar tissue, which irritates the nerves and it becomes a vicious cycle.
How does it start?
My patients tell me that they get a feeling of tightness and fullness in their wrist and forearm first. This can last from weeks to months. If it is not worked on or worked with at this stage, it will progress. read below under conservative care). In fact, at this stage, it is not even named carpal tunnel syndrome. It is just a tightness in the forearm and wrist that will likely eventually lead to CTS.
The Classic Symptoms if CTS:
Numbness and tingling in the thumb, index and middle finger are the usual signs. Some complain their entire hand goes numb. The feelings may come and go from dropping of small object to dis-coordination during small motor tasks typing, using a palm pilot/phone). Folks may complain of waking with numb hands or pain in the area.
Worst Case: Surgery $50,000?
I am not a surgeon. But I know some, and they do good work. I personally, would leave this option until the very last. It’s pretty invasive, and everything else should be tried first! The surgical procedure involves a snipping if the sheath that surrounds the tunnel.
So, I ask: if you can snip is later, why can’t you stretch it in the early stages when the area first starts to tighten up?
I treat conservatively. In the following paragraphs, I will describe some of the things I do/use/recommend. However: I have seen enough cases of this in my life to know when to quite while I’m ahead. I seldom take a case that has progressed to the stage of numbness. If I do, I will only see it for 8 visits. If I see no improvement at all, I refer both to a Physical therapist and to an orthopedic surgeon concurrently. Remember: the longer it goes on, the harder it is to treat conservatively.
Best Case: Catch it early!
When the tightness starts, and the numbness, pain and dis-coordination have not yet arrived is the time get conservative care.