Carpal Tunnel Syndrome (CTS) is caused by pinching of the median nerve inside the carpal tunnel in the wrist resulting numbness, tingling, and sometimes pain into the hand affecting the index, 3rd, and thumb-side of the 4th finger. Grip strength weakness may occur (usually later in the process), making dropping of items and fine motor activities, like buttoning shirts, challenging. There are many approaches to the treatment of CTS of which surgical release of the transverse carpal ligament is the most common and usually recommended by most primary care physicians when tests support the presence of CTS. But, there are alternative treatment approaches that should be utilized first because the recovery time is less lengthy and grip weakness often occurs post-surgically with approximately a 30% loss of strength. Moreover, the CTS sufferer will lose minimal or no work time when treated with chiropractic approaches, compared to a 2 to 6 week work loss time after surgery, if there are no complications. Bottom line, there are no serious side effects to chiropractic management of CTS so, why wouldn’t you try that first since there are potential side effects to the surgical approach?

So, what can you expect when you present for chiropractic management of CTS?

The history process includes how the condition started (“mechanism of injury”), the date of onset, activities that make the condition better and worse, the quality of symptoms, the location of symptoms, the severity (0-10 scale usually), and when the condition is worse (such as night time when sleeping). There are special questionnaires that ask about symptom severity and function loss which are scored and used to track progress during treatment. A pain diagram is completed by the patient that illustrates where the patient has pain, numbness or other symptoms on a map of the body. This is important as frequently in CTS, there are areas in the neck, shoulder, arm as well as the wrist and hand that are present in patients with CTS and successful management of CTS depends on treating ALL areas involved, NOT just the wrist/hand.

The examination of the CTS patient includes observing posture for a forward head position, protracted or rolled forward shoulders, muscle bulk of the arms, and if there is any abnormal spinal curvature or head tilt. The skin is also inspected for lesions, rashes, discoloration, swelling and hair loss. Next is palpation where we determine if there are any subluxations (vertebral and/or extremity joint misalignments) and/or trigger points in muscles including the neck, shoulders, arms and hands. Orthopedic tests are performed where we put the neck, shoulder, arm and hand in various positions to see if the symptoms of CTS change. These tests give us clues as to which tissues are contributing to the CTS symptoms. For example, applying thumb pressure over the carpal tunnel will often reproduce the CTS symptoms of numbness and/or pain into the index, 3rd, and thumb half of the 4th finger. When we find multiple tests that reproduce the CTS symptoms, we will know what areas require treatment as frequently, we will find a significant contribution to the CTS symptoms are coming from the neck, shoulder, and/or forearm, NOT JUST the wrist. This is why, in some cases, patients may not have a satisfying result after CTS surgery.

The treatment the CTS patient may expect at the chiropractic office includes manipulation of the neck, shoulder, elbow, wrist and hand. We will often perform muscle release techniques where pressure is applied into the muscles during stretch as well as friction massage. The use of a wrist “cock-up” splint at night is very helpful to reduce the frequency of waking up at night due to hand/finger numbness. Various physical therapy modalities such as low level laser therapy, electrical stimulation, pulsed magnetic stimulation, ultrasound, and others can also be helpful. Also, we give exercises that are extremely helpful and we frequently discuss job modifications to helps to reduce the repetitive strain that causes and can prolong the condition.

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.

Carpal Tunnel Syndrome (CTS) is caused by pinching of the median nerve inside the carpal tunnel in the wrist resulting numbness, tingling, and sometimes pain into the hand affecting the index, 3rd, and thumb-side of the 4th finger. Grip strength weakness may occur (usually later in the process), making dropping of items and fine motor activities, like buttoning shirts, challenging. There are many approaches to the treatment of CTS of which surgical release of the transverse carpal ligament is the most common and usually recommended by most primary care physicians when tests support the presence of CTS. But, there are alternative treatment approaches that should be utilized first because the recovery time is less lengthy and grip weakness often occurs post-surgically with approximately a 30% loss of strength. Moreover, the CTS sufferer will lose minimal or no work time when treated with chiropractic approaches, compared to a 2 to 6 week work loss time after surgery, if there are no complications. Bottom line, there are no serious side effects to chiropractic management of CTS so, why wouldn’t you try that first since there are potential side effects to the surgical approach?

So, what can you expect when you present for chiropractic management of CTS?

The history process includes how the condition started (“mechanism of injury”), the date of onset, activities that make the condition better and worse, the quality of symptoms, the location of symptoms, the severity (0-10 scale usually), and when the condition is worse (such as night time when sleeping). There are special questionnaires that ask about symptom severity and function loss which are scored and used to track progress during treatment. A pain diagram is completed by the patient that illustrates where the patient has pain, numbness or other symptoms on a map of the body. This is important as frequently in CTS, there are areas in the neck, shoulder, arm as well as the wrist and hand that are present in patients with CTS and successful management of CTS depends on treating ALL areas involved, NOT just the wrist/hand.

The examination of the CTS patient includes observing posture for a forward head position, protracted or rolled forward shoulders, muscle bulk of the arms, and if there is any abnormal spinal curvature or head tilt. The skin is also inspected for lesions, rashes, discoloration, swelling and hair loss. Next is palpation where we determine if there are any subluxations (vertebral and/or extremity joint misalignments) and/or trigger points in muscles including the neck, shoulders, arms and hands. Orthopedic tests are performed where we put the neck, shoulder, arm and hand in various positions to see if the symptoms of CTS change. These tests give us clues as to which tissues are contributing to the CTS symptoms. For example, applying thumb pressure over the carpal tunnel will often reproduce the CTS symptoms of numbness and/or pain into the index, 3rd, and thumb half of the 4th finger. When we find multiple tests that reproduce the CTS symptoms, we will know what areas require treatment as frequently, we will find a significant contribution to the CTS symptoms are coming from the neck, shoulder, and/or forearm, NOT JUST the wrist. This is why, in some cases, patients may not have a satisfying result after CTS surgery.

The treatment the CTS patient may expect at the chiropractic office includes manipulation of the neck, shoulder, elbow, wrist and hand. We will often perform muscle release techniques where pressure is applied into the muscles during stretch as well as friction massage. The use of a wrist “cock-up” splint at night is very helpful to reduce the frequency of waking up at night due to hand/finger numbness. Various physical therapy modalities such as low level laser therapy, electrical stimulation, pulsed magnetic stimulation, ultrasound, and others can also be helpful. Also, we give exercises that are extremely helpful and we frequently discuss job modifications to helps to reduce the repetitive strain that causes and can prolong the condition.

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.

Because carpal tunnel syndrome (CTS) is technically a tendonitis that happens to be near a nerve (the median nerve), one treatment option for CTS is to manage the tendonitis and by doing so, the pressure on the median nerve will resolve. Also, because the movement of the hand and wrist are controlled by opposite functioning muscles (that is, when we flex the wrist and fingers, the palm side tendons are doing the job and when we extend the wrist/fingers, the back of the forearm and hand tendons are doing the work), these opposite functioning actions need to be balanced. Moreover, if the muscles on one side of the forearm are tight and inflamed, very often so are the muscles on the opposite side.

Therefore, an exercise program for the forearm and hand should include BOTH sides, not just the flexor or palm side of the forearm/hand where the carpal tunnel is located. Perform these exercises multiple times a day for 3-10 second hold times. You can modify #2 and #3 by NOT using the opposite hand to pull but rather, simply make the movement without the opposite hand assisting in the stretch. That way, you can perform BOTH at the same time IF your time is short (such as when performing these during a busy work day, for example).

Feel for the stretch where the arrows are pointing – it should be a “good” hurt/stretch!

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.

People who spend a lot of time performing activities that require a high level of force, repetition, or use vibrating tools are at risk of developing carpal tunnel syndrome (CTS). Other activities such as driving, playing musical instruments, knitting, using a sander, screw drivers, air wrenches, waitress work, or assembling small parts are also associated with increased CTS risk. The good news: there are ways we can reduce the risk of developing CTS. Some of these include the following:

1. Stay Healthy: There are many conditions that contribute to the onset and/or make CTS worse. Exercise, maintain a healthy weight (Body Mass Index – BMI – of 25 or less), stop smoking (or better yet, never start), take your thyroid medication (if indicated), keep your blood sugar normal (obesity leads to diabetes which often worsens CTS), and do your carpal tunnel exercises multiple times a day.
2. Ergonomics: Use “ergonomic” principles when arranging your workstation such as sitting properly at your home and work computers. The placement of your desk, the computer monitor, the keyboard (consider a convex keyboard rather than the flat type), the mouse (and type of mouse – the track ball mouse requires no arm movement, only the thumb), paperwork space and location. The type of chair and its height are also very important. Avoid desks that have sharp edges as they can compress the forearms and pinch the CTS nerve.
3. Posture: The position in which you sit is important! Sit in an upright position, head/chin tucked in, feet on the floor or on a box, elbows resting on adjustable arms of the chair bent about 90 degrees, and keep your wrists fairly straight/neutral. Avoid slouching, reaching out with the elbows less than 90 degrees, head shifted forwards and shoulders rounded and feet not positioned under you. When you talk on the phone, STRONGLY consider a headset! Pinching the phone between your shoulder and ear with your head bent sideways for any length of time is a ticket to disaster for developing CTS and/or other types of cumulative trauma disorders (pinched nerves in the neck, shoulder tendonitis/bursitis, elbow tendonitis and more).
4. Plan your activities: Pay careful attention to your daily routine for activities that may increase your risk of developing or perpetuating CTS. For example, these activities can increase your chance of developing or worsening CTS: playing a musical instrument, knitting, carpentry, playing video or computer games for hours, working on cars, operating vibrating tools, using forceful gripping such as spray bottles, using a crutch, cane, wheelchair, engaging in certain sports such as long-distance cycling that load the arm and hand, skiing – waterskiing requires a firm grip on the handle and snow skiing requires firm gripping on the ski pole.
5. Sleep: It is impossible to control the position we put our hands/wrists in at night. Therefore, it is essential to wear wrist splints so we avoid bending the wrists in our sleep. Many of us curl up in a ball and tuck or bend the wrists and hands under our chin. In a “normal” wrist, the pressure inside the carpal tunnel DOUBLES when we bend our wrists! If we have CTS, the pressure goes up exponentially or, 6-8 times because of the increased pressure that’s there already because of the CTS. Use a pillow that is designed for you, we’ll help you with that!
6. Take a break! It’s important to pace yourself if your work or play includes fast, repetitive activities. It’s easy to get lost into what you’re doing so a timer to remind you that an hour has gone by and to take a break is a wise purchase. There are computer programs that flash on your screen, “Time to stretch!” Some of these may include the actual exercise so you don’t forget what to do. If not, talk to us about what exercises are good to do either at the workstation and/or at home for CTS.

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.

People who spend a lot of time performing activities that require a high level of force, repetition, or use vibrating tools are at risk of developing carpal tunnel syndrome (CTS). Other activities such as driving, playing musical instruments, knitting, using a sander, screw drivers, air wrenches, waitress work, or assembling small parts are also associated with increased CTS risk. The good news: there are ways we can reduce the risk of developing CTS. Some of these include the following:

1. Stay Healthy: There are many conditions that contribute to the onset and/or make CTS worse. Exercise, maintain a healthy weight (Body Mass Index – BMI – of 25 or less), stop smoking (or better yet, never start), take your thyroid medication (if indicated), keep your blood sugar normal (obesity leads to diabetes which often worsens CTS), and do your carpal tunnel exercises multiple times a day.
2. Ergonomics: Use “ergonomic” principles when arranging your workstation such as sitting properly at your home and work computers. The placement of your desk, the computer monitor, the keyboard (consider a convex keyboard rather than the flat type), the mouse (and type of mouse – the track ball mouse requires no arm movement, only the thumb), paperwork space and location. The type of chair and its height are also very important. Avoid desks that have sharp edges as they can compress the forearms and pinch the CTS nerve.
3. Posture: The position in which you sit is important! Sit in an upright position, head/chin tucked in, feet on the floor or on a box, elbows resting on adjustable arms of the chair bent about 90 degrees, and keep your wrists fairly straight/neutral. Avoid slouching, reaching out with the elbows less than 90 degrees, head shifted forwards and shoulders rounded and feet not positioned under you. When you talk on the phone, STRONGLY consider a headset! Pinching the phone between your shoulder and ear with your head bent sideways for any length of time is a ticket to disaster for developing CTS and/or other types of cumulative trauma disorders (pinched nerves in the neck, shoulder tendonitis/bursitis, elbow tendonitis and more).
4. Plan your activities: Pay careful attention to your daily routine for activities that may increase your risk of developing or perpetuating CTS. For example, these activities can increase your chance of developing or worsening CTS: playing a musical instrument, knitting, carpentry, playing video or computer games for hours, working on cars, operating vibrating tools, using forceful gripping such as spray bottles, using a crutch, cane, wheelchair, engaging in certain sports such as long-distance cycling that load the arm and hand, skiing – waterskiing requires a firm grip on the handle and snow skiing requires firm gripping on the ski pole.
5. Sleep: It is impossible to control the position we put our hands/wrists in at night. Therefore, it is essential to wear wrist splints so we avoid bending the wrists in our sleep. Many of us curl up in a ball and tuck or bend the wrists and hands under our chin. In a “normal” wrist, the pressure inside the carpal tunnel DOUBLES when we bend our wrists! If we have CTS, the pressure goes up exponentially or, 6-8 times because of the increased pressure that’s there already because of the CTS. Use a pillow that is designed for you, we’ll help you with that!
6. Take a break! It’s important to pace yourself if your work or play includes fast, repetitive activities. It’s easy to get lost into what you’re doing so a timer to remind you that an hour has gone by and to take a break is a wise purchase. There are computer programs that flash on your screen, “Time to stretch!” Some of these may include the actual exercise so you don’t forget what to do. If not, talk to us about what exercises are good to do either at the workstation and/or at home for CTS.

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.

Have you ever woken up in the middle of the night and noticed your hand sleeping to the point where you had to get out of bed and shake or flick your fingers to alleviate the numbness? If the numbness was primarily on the thumb-side half of your hand, it may have been carpal tunnel syndrome that woke you up. So, the question is, why is it such an issue at night?

To properly answer this question, let’s get familiar with the anatomy of the wrist. There are 2 bones that make up the forearm – the ulna (on the pinky side) and the radius (on the thumb side). Just beyond that, there are two rows of four bones each called the carpal bones for a total of 8 small bones that make up the wrist joint. These carpal bones are arranged in a horseshoe or tunnel shape. When you look down at your wrist and wiggle your fingers quickly, you can see all the movement that occurs on the palm side of the wrist. That’s a lot of movement! You can also see the muscles on the upper half of the forearm moving rapidly as the fingers wiggle.

There are 9 muscle tendons that travel through the carpal tunnel, as well as some blood vessels and most important, the median nerve sits on top of all those moving tendons. Just beneath the floor of the tunnel is a ligament called the transverse carpal ligament. The tendons inside the tunnel are surrounded by lubricating sheaths that make it easier for the tendons to slide back and forth as we wiggle our fingers, grip to open a jar, type on a computer, play a musical instrument, or so on. Without the tendon sheaths, the friction between the rubbing tendons would quickly build up heat, resulting in swelling, pain and numbness. However, in spite of the lubricating function of the sheaths, when we work our fingers and hands too much, swelling and inflammation does occur.

So, why do we have numbness at night when we aren’t working, gripping and moving our fingers repetitively? The answer lies in how we sleep. Since we are asleep, we cannot control where we position our hands and wrists. Most of us curl up in a ball and tuck our hands under our chin or someplace cozy. Normally, when we bend our wrists, the pressure inside the carpal tunnel doubles. However, a carpal tunnel patient already has a higher level of pressure in their wrist. So, when a carpal tunnel patient bends their wrist in the exact same way, the pressure goes up even more – that is, 3, 4, 5, or more times than a normal person without their wrist bent. That is why a wrist “cock-up” splint works so well at night! It keeps the wrist straight so we can’t bend it. Often, this allows the CTS patient to sleep through the night instead of waking up 2, 3, or more times with numbness, tingling, and/or pain on the thumb half of the hand.

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.

Carpal Tunnel Syndrome (CTS) is a condition that results from pressure applied to the median nerve on the palm side of the wrist that causes numbness, tingling, weakness, and/or muscle damage affecting the thumb side of the hand and fingers, including the thumb, index, 3rd and thumb side of the 4th finger. There is literally a tunnel through which 9 tendons and their sheaths, some blood vessels, and most importantly, the median nerve travel through to get to the thumb and fingers. As these tendons slide back and forth in their sheaths, friction can build up, leading to swelling when fast, repetitive finger related work is performed, especially for prolonged time frames. The “syndrome” starts when the swelling occurs and the numbness/tingling/weakness complaints begin.

There are many causes of CTS. Most commonly, CTS occurs in people whom perform fast, repetitive motions including (but not limited to): typing on a computer keyboard, using a computer mouse, sewing, driving, assembly line work, painting, writing, use of hand tools, sports such as racquetball or handball, and playing musical instruments. Many of these tasks involve bending or twisting of the wrists (think of a violin or flute player and you get the picture). CTS most often occurs in people 30-60 years old, affects women more than men and, can be either caused or contributed by other conditions such as fracture/trauma to the wrist or hand, arthritis of the wrist, diabetes, alcoholism, hypothyroid, kidney failure and dialysis, menopause, premenstrual syndrome (PMS), and pregnancy, infections, obesity, rheumatoid arthritis, SLE, and others.

Symptoms most commonly include numbness or tingling in the thumb-side palm, thumb, 2nd, 3rd, and thumb half of the 4th fingers. The symptoms can extend to the elbow or higher to the neck or shoulder, can affect both hands (but one is usually worse than the other), and can interfere with daily activities such as buttoning shirts, opening jars, holding onto the steering wheel, riding a bike, working with the hands, etc.

During an initial examination, a Doctor of Chiropractic exam will often check your sensation with a sharp pointed object, percuss over the palm-side wrist, ask you to hold your hands back to back and palm to palm while counting the seconds to numbness, test grip strength, and also check the neck, shoulder and elbow as these areas refer pain back and forth. Sometimes, he or she will order an EMG to test the nerve’s damage. Conservative chiropractic treatment is highly effective and DEFINITELY should be done FIRST, before injections, medications, or surgery!

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.

The word “Ergonomics” is thrown around a lot when it comes to Carpal Tunnel Syndrome (CTS). The term ergonomics comes from the Greek ergon, meaning “work”, and nomos, meaning “natural laws.” By definition, ergonomics means, “…the study of efficiency in working environments.” Wikipedia describes it as, “…the study of designing equipment and devices that fit the human body, and its cognitive abilities.” The International Ergonomics Association offers this definition: “Ergonomics (or human factors) is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance.”

The study of ergonomics is not new as it dates back to Ancient Greece with substantial evidence that, in the 5th century BC, ergonomic principles were applied to tool design, jobs and workplaces. Examples include Hippocrates giving surgeons recommendations on how to arrange their table and tools during surgery.

Some ergonomic concepts we can employ on a daily basis include:

1. Take frequent breaks, every half-hour if possible, but at least every 60 to 90 minutes. Get up, stretch and walk around. If nothing else, perform stretches while sitting in your work chair.
2. Maintain “good posture” (tuck in the chin and hold the retracted position).
3. Evaluate your workstation: proper sitting position, how you hold the phone, keyboard/monitor positions, type & position of the mouse, reaching requirements, avoid twist/bending the wrists.
4. When grasping/gripping, use the whole hand – not just the fingers or thumb tips alone.
5. Keep cutting instruments sharp (scissors, knives, etc.) and maintain locks on hinged knives.
6. Consider modifications if tools are too heavy, buttons too high, too much required force, etc.
7. Stay in shape as obesity is a risk factor for carpal tunnel syndrome.
8. Rotate job tasks rather than continuing with one task until finished (less repetition)!
9. Communicate with your supervisor and HRO person about improving the workplace.

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.