Carpal Tunnel

CARPAL TUNNEL The medical term for the wrist is “carpus”. The bones and ligaments of the wrist form a small tunnel that the nerves, blood vessels and tendons have to pass through to reach the hand.This is the carpal tunnel. Normally, this tunnel is large enough for all the structures that pass through, but if there is a lot of swelling or scarring in the area, the tunnel will close up, irritating the nerves. Repetitive use of the wrist can cause this swelling and scarring. If the nerve is irritated, the thumb and first finger are affected the worst. They are usually weak and have numbness or “pins and needles” feeling. If these is severe scarring, surgery is needed to release the pressure in the area and open up the tunnel.

Carpal tunnel is usually a “cumulative” problem, meaning that it builds up gradually over time rather than coming on with one injury. With a huge increase in the use of computers, it is quickly becoming a very common problem.

Most people do not think of this as a condition that chiropractors can treat. However, in many cases relief can be found from chiropractic care in several ways. If the wrist bones (there are eight in the wrist alone) are out of alignment, repetitive use of the wrist is very irritating. The wrist can swell, closing down the carpal tunnel, adding to the nerve irritation. Chiropractic treatment to the joints of the wrist can restore normal function to the wrist, easing the irritation that follows repetitive use.

The treatment does not directly increase the size of the tunnel; instead, it prevents the swelling in the first place. This type of wrist problem is really no different than the problems that chiropractors treat in the spine. Just like spinal treatment, the joints are manipulated gently to allow them to work normally. This reduces stress and irritation in the joints.

Also, there is a wrist brace that was developed by a chiropractor that is unique. This brace squeezes the bones of the wrist together gently, opening up the tunnel, and easing the nerve irritation. Some people have found this brace alone is enough to keep them from surgery. Lastly, neck problems are an important secondary cause of carpal tunnel. Some patients have noticed improvement of their carpal tunnel with treatment of the neck only. These patients had nerve irritation at the neck, and then again at the wrist. When the irritation at the neck was corrected, it made the nerve less irritated and painful at the wrist.

A small number of patients find that their wrist problems are completely gone when the neck is treated. In these cases, the neck problem is enough to directly irritate the nerves as they leave the neck to travel down the arm. In other cases, the neck problem does not cause true nerve irritation, but instead causes referred pain in the hand. One muscle in particular is known for causing this problem- the scalene muscle. A problem in this muscle usually does not cause neck pain, but will be felt in the hand- especially in the thumb and first finger, just like true carpal tunnel. I have seem many patients go through a lot of testing (some of it, like the EMG test, can be painful) only to be told everything looks normal, or nearly so. Most of these cases are ot true carpal tunnel. Their problems are in the neck. I have seen many wasted treatments, including surgeries, in these cases.

Most of these patients do not have a lot of pain in the neck. There may be occasional stiffness at the end of the day, but there is a lot more pain and numbness in the hand and wrist than in the neck. However, unless the neck is treated there will be little overall improvement.

If you know someone suffering with carpal tunnel, have them call a chiropractor for a consultation. With proper treatment, most of these cases do very well, and many have found relief with chiropractic care even after surgery.