Every day we text, type, and do our daily chores, we might be placing a whole lot of stress on our hands and wrists which may lead to carpal tunnel syndrome.
So, what are the ways to prevent and reduce the risk of CTS?
Dr. Allen Conrad, BS, DC, CSCS
Owner, Montgomery County Chiropractic Center | Team Chiropractor, Blackthorn Rugby Team
What Is CTS?
Carpal Tunnel Syndrome (CTS) is a condition which causes wrist pain, weakness, and numbness from compression of the median nerve as it passes through the carpal tunnel in your wrist. This small area develops scar tissue or degenerative arthritis from repetitive wrist motions like typing. CTS can cause numbness, pain, weakness, and can require surgery if left untreated.
How Do You Prevent CTS?
CTS occurs from repetitive wrist motions done for long periods of time without rest. Frequent rest breaks between long sessions of typing, or working on your car can help. If rest doesn’t do the trick, our office recommends a combination of chiropractic care, massage therapy, therapeutic exercise and therapeutic ultrasound for CTS.
Chiropractors can adjust any of the carpal bones that are misaligned and maintain that your wrist has a full range of motion. Massage therapy is effective for helping break up scar tissue associated with tight and sore muscles.
Therapeutic wrist extension exercises can help strengthen the wrist so it is less likely to become sore with repetitive activities. Therapeutic ultrasound is a machine that uses ultrasound waves while applied to the wrist to decrease inflammation that is associated with CTS.
Other helpful ideas include proper wrist ergonomics while typing.
Ergonomic Recommendations for Good Desk Posture
- To keep the wrist in the proper posture for alignment, the wrist should be slightly extended during typing, but not more than 15 degrees from a lateral view. This neutral position with slight extension will help alleviate additional stress on the muscles and tendons of the wrist and elbow. The chair height from a lateral view should be equal to the keyboard, with the elbow/forearm angle at 90 degrees.
- All ergonomic keyboard are not equal, due to the fact that all wrists and arms are different sizes. Important factors for an ergonomic keyboard include a comfortable feel during use, with a reinforced cushioned wrist pad. The keyboard should have a slight elevation that angles towards the person typing.
- Tablets can cause additional stress on the wrist, elbow, and shoulder since they do not allow the same ergonomic posture as the traditional keyboard. For extended periods of typing, stick to the old fashioned keyboard and use the tablet for occasional uses.
Chiropractor | Specialist in Applied Kinesiology |
Author, Journey to Healing: The Art and Science of Applied Kinesiology
Many people are not aware that there is a medical specialty known as Applied Kinesiology that uses muscle testing and integrates various procedures such as chiropractic, medical massage, acupuncture, nutrition and exercise to help you with most conditions, Here is an example of a woman with carpal tunnel syndrome.
Carpal Tunnel Syndrome
Cindy was a cashier at Costco. She had been experiencing severe hand and wrist pain for months that has progressively been getting worse. She had taken to wearing a brace, tried the prescribed drug Neurontin, did her physical therapy faithfully and had one cortisone shot, all of which did not remedy her condition.
The company offered her disability or a job change but she thoroughly enjoyed her work and respectfully refused both. A coworker told Cindy about her success seeing an Applied Kinesiologist for the same condition and gave her the name of her doctor.
Carpal Tunnel Syndrome is a condition whereby the median nerve that travels down from the neck into the hand is compressed at the carpal tunnel. The main symptoms are pain, numbness, tingling, and increasing hand weakness. Patients will often complain of dropping things or being unable to open containers that they used to open with ease.
The patient consultation, which included Cindy wearing a very large and immovable wrist splint, and standard orthopedic tests all pointed to a clear diagnosis of carpal tunnel syndrome (CTS). The Applied Kinesiology (AK) examination went further to specific muscle test the main muscle in the hand controlled by the median nerve, the Opponens Pollicus. This is the muscle that moves the thumb towards the pinky and begins to waste away (atrophy) depending on the chronicity of the problem.
A hallmark of AK muscle testing is the ability to ascertain where the cause of muscle dysfunction is occurring. In Cindy’s case, as in all cases of CTS, if the median nerve is being compressed and affecting the function of the thumb muscle (Opponens Pollicus) AK muscle test can reveal where the compression is occurring.
The carpal tunnel is a narrow passageway located in the area of the palm and wrist. An arch comprised of carpal bones on three sides and a ligament in the front forms this tunnel that your median nerve traverses through. Theoretically, the tunnel becomes compromised and compresses the nerve causing the symptoms of pain, numbness, and weakness.
Currently, the surgical treatment consists of opening the tunnel by severing the ligament. Applied Kinesiology protocol is predicated on the belief that the more likely cause of the collapse of the tunnel is from one of the carpal bones slipping out of place. Applied Kinesiologists prefer to restore the integrity of the tunnel by realigning any of the carpal bones that may have slipped into the tunnel.
The AK procedure is to test the thumb muscle if it is shown to be weak to then proceed to have the patient activate the carpel tunnel by pressing on the various carpal bones and see if this causes an improvement in the function of the affected muscle. If a positive response is noted then the doctor performs a static challenge by pressing the specific carpal bones to see which is the culprit.
When the offending bone is found that is collapsing the tunnel the patient’s hand muscle will test dramatically stronger. Treatment is to restore the tunnel to its normal patency by realigning the misaligned bone to its former proper position through a chiropractic adjustment either by hand or by using an adjusting devise known as an Arthrostim®.
In Cindy’s case, the doctor made the anatomical correction to the carpal bones and gave rubber band exercises to strengthen the neglected finger extensor muscles to help keep the tunnel open.
Since the patient did not want to miss work the treatment required twelve sessions to restore and maintain the integrity of the tunnel because she continued to use the hand throughout therapy. The patient went on to completely recover full strength and pain-free use of her hand.
Brian Zafonte, MD, PhD
Orthopedic Surgeon, Ascension Medical Group
Carpal tunnel syndrome is a common condition that causes numbness, tingling, and pain in the hand and wrist and affects many people of all ages.
It is caused by pressure on your median nerve, which controls movement and feeling in almost all your fingers. Individuals who spend more time using technology including mobile phones, tablets, and computers, report more pain in their wrists and hands than their peers who spend less time each day using electronic devices.
There is no one proven strategy to prevent carpal tunnel syndrome but as technology continues to play a greater role in our daily lives, here are seven ways to minimize stress on your hands and wrists:
- Pay attention to your posture. For most of us who work on computers all day, this is especially important. Practice good posture to prevent your shoulders from rolling forward, which can affect your wrists, fingers, and hands.
- Make sure your workstation is set up correctly. Adjust the placement of your desk, chair, and computer monitor to meet ergonomic guidelines. Keep your keyboard at elbow height or slightly lower.
- Take frequent breaks and stretch often. Even a short break to stretch your hands, wrists and neck can help.
- Alternate your motions. One of the most common ways of developing carpal tunnel is repetitive, resistive wrist activities. Avoid doing the same motions repeatedly to give your muscles a break.
- Keep your hands warm. Hand pain can develop more often if you work in a cold, environment.
- Keep glucose levels under control. Individuals with diabetes are 15 times more likely to develop carpal tunnel syndrome. Prevent type 2 diabetes with a healthy diet and regular exercise.
- Ease up your grip. Hit the keys on your keyboard softly and if you work with tools for a living, try loosening your grip.
Dr. Daniel Paull
Orthopedic Surgeon | Founder & CEO, Easy Orthopedics
When most people think of carpal tunnel syndrome, they usually just think about the median nerve being compressed. There are also 9 tendons (all of the tendons that flex your fingers and thumb), right alongside the nerve making the carpal tunnel, making it a rather cramped space.
If the tendons are irritated then the nerve can also be irritated, so prevention comes down to two basic tenets: keeping your wrist in a neutral position will create more space in the tunnel, and keeping your tendons and nerve gliding will prevent them from getting irritated. Here are some specific things that someone can do to prevent carpal tunnel syndrome:
- Don’t lean your hands on the keyboard wrist pad while you are typing. This will force your wrist into extension, and place strain on the nerve and tendons. The best position for typing is to have your elbows at 90 degrees, and your hands hovering over the keyboard while typing. The wrist pad is for resting your wrist when you are NOT typing.
- Avoid any positions that cause your wrist to be flexed or extended for long periods of time. Movement is good, but staying static in these positions can irritate the nerve or tendons
- Stretch your hands and wrist regularly. These are also referred to as nerve gliding exercises and can be a treatment as well as a prevention technique. The carpal tunnel wrist stretch is when you put your palm upwards and bend your fingers and thumb back. Hold this for 10 seconds a few times a day, and do not do it if it causes pain.
Dr. Stephen O’Connell
Orthopedic Surgeon | Board Member, Eisenhower Hospital
Carpal Tunnel Syndrome
Although not typically considered a sports injury, the pervasive nature of carpal tunnel syndrome warrants a brief discussion. Classically, patients experience numbness, tingling and/or pain in one or both hands. Pain is often worse at night and will frequently disrupt sleep.
Positional symptoms are also common and may occur with activities such as driving, holding a book or newspaper, and talking on the phone. The source of this problem is a compressed or “squeezed” nerve in the carpal tunnel located in the wrist. Incidentally, the most common cause of this problem is inflammation of the tendons in the tunnel, thus increasing the pressure on the nerve.
There is a popular misconception that as we age, aches and pains are to be expected, and when they occur, tolerated. While it is true that overuse injuries are more prevalent as we age, aging, in and of itself, is not the cause nor the diagnosis.
Many times, individuals will not seek medical attention for an overuse injury because they fear the treatment. Concerns over lengthy and perhaps painful treatments, coupled with the fear that they may have to give up the activities they enjoy, impede early diagnosis, treatment, and restoration of full function.
However, the majority of conditions such as carpal tunnel syndrome can be treated with simple modalities. These include rest, modification, therapy and anti-inflammatories — oral, topical and injectable.
In cases that are not amenable to these conservative therapies, a minimally invasive surgical procedure may be recommended. These procedures are typically done in an outpatient surgical center, rarely requiring general anesthesia. Comprehensive follow-up ensures a speedy recovery and an optimal outcome, guaranteeing a quick return to everyday life.
Hand and Upper Extremity Orthopedic Surgeon
Get rid of hormones that cause fluid retention and thickening of the extracellular matrix. It is a metabolic problem. If prone, wearing a splint to minimize flexion of the wrist, mainly at night, will stave off systems.
Some studies have shown stretching helps (nerve gliding exercises) as well as Vitamin B6 and perhaps antioxidants like Turmeric.