Carpal Tunnel Syndrome

The year 2010 has brought new and exciting changes to the office. I (Dr. Dan) will be entering my second year in practice. As such, we have expanded to nine treatment rooms (4 chiropractic, 5 acupuncture, and oriental medicine), not including the dedicated therapy room.

This expansion will also accommodate a third doctor (Benjamin Myerowitz) when he joins the practice in January of next year. Having the extra rooms and equipment will make scheduling much easier. Our average wait time continues to be less than 5 minutes.

We’ve also added a new staff member at the front desk. The new radiant smile that greets all visitors during the afternoon hours belongs to Pam Seymour. Please help her feel at home.

As the heat of the summer has hit us in full swing and we sit at our desks longing for the outside while staring into a computer screen (as I’m doing now), I would like to take a moment to address a particularly puzzling condition that often results in unnecessary surgeries and less than desired outcomes. It was the buzz-word condition of the 1990s, Carpal Tunnel Syndrome.

Carpal Tunnel Syndrome is the most common nerve compression syndrome of the upper extremity, affecting 1% of the U.S. population and potentially up to 5% of the workforce who must rigorously use their hands in their jobs. Carpal Tunnel Release Surgery is the most common surgery for the hand and wrist. More than 460,000 such procedures are performed annually. [i]

Here’s a quick brief on the technical stuff.

True Carpal Tunnel Syndrome is the compression of the median nerve as it passes through the wrist and into the hand. The median nerve is a very large nerve composed of four nerve roots (nerves that exit the spine). The spinal nerve roots that come together to form the median nerve are the C6, C7, C8, and T1.

These levels are located in the mid to lower neck. The median nerve is formed from the brachial plexus as a confluence of these nerve roots. Then, it begins its journey through the shoulder, down through the pronator teres muscle at the elbow, then down the forearm, through the carpal tunnel, and into the hand.

An arch of three wrist bones forms the carpal tunnel. The transverse carpal ligament is a thick, soft tissue band around the wrist like a wristband. The median nerve shares the tunnel with nine tendons from muscles in the forearm that move the hand and fingers.

Carpal Tunnel Syndrome can be caused by many factors with the most common being idiopathic, that is, of unknown cause. This is an interesting point to make as CTS (Carpal Tunnel Syndrome) is often used as a diagnosis of ease. If you have pain, numbness, or weakness in the hand, you are often slapped with a CTS diagnosis.

Compression of the median nerve can happen in several locations. In the neck due to cervical disc prolapse (herniation), compression at the shoulder, compression at the elbow under a muscle, and compression at the wrist can all mimic Carpal Tunnel Syndrome. Sensory (touch) deficits due to impingement are vital in diagnosing this condition.

Carpal Tunnel Syndrome will only affect sensation in the thumb and first two fingers. It will never cause tingling and numbness in the palm as the median nerve branch innervates the palm exits’ skins before the nerve passes through the carpal tunnel. If such loss of sensation in the palm does exist, then the real culprit is compression of the nerve at the elbow by the pronator teres muscle, responding quickly to conservative treatment.

Medical management of CTS is geared towards resolving symptoms and does not solve the problem that caused the condition. After cortisone injections to decrease inflammation, splinting, and stretching, the next step is often surgery to release the transverse carpal ligament. This is often successful in relieving the pressure on the nerve if it is truly compressed in the tunnel, but has side effects of scarring, possible nerve damage, recovery time, and permanence.

In our office, we consistently have great success in managing all nerve compression conditions. When a person comes in to see us complaining of pain, weakness, and numbness in the upper extremity, we always check for problems in the neck that are often the original cause of the problem. Subluxation in the neck causes impingement on the spinal nerve roots that can cause symptoms elsewhere.

We are also careful to distinguish between entrapment of the nerve at the elbow and the wrist. Often, subluxation of the lunate (a small bone in the wrist that forms the keystone to the arch of the carpal tunnel) is enough to narrow the carpal tunnel and cause symptoms. The correction of this misalignment is simple and has fantastic results.

If you, a friend, or a loved one is struggling with any nerve compression condition and not seeing the desired results elsewhere, then we would love to see you. Helping you avoid surgery and get on the path towards wellness is our goal. To start your path to wellness, please call the office at 207-989-0000 to set up an appointment. My door is always open.

Daniel J. Myerowitz, D.C., Dipl. Ac. (AACA)
Myerowitz Chiropractic & Acupuncture Clinic
291 Main Road
Holden, ME 04429

[i] Plastic and Reconstructive Surgery: Volume 105(5)April 2000pp 1662-1665 The Incidence of Recurrence after Endoscopic Carpal Tunnel Release. Concannon, Matthew J. M.D.; Brownfield, Mona L. M.D.; Puckett, Charles L. M.D

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