Robert Hayden, DC, PhD, FICC
Technology is a marvelous part of our everyday lives. Very few people on the street today can remember times when you could not pick out a device from your purse or off your belt and make a quick phone call to a friend in Tokyo, or ask a knowledgeable, but impersonable voice for information from the unlimited Internet. There are some costs involved, however, and we see them every day at the clinic.
There is a tight space on the inside of your wrist where several tendons are organized in a sheath by a ligament that runs across the wrist parallel to where your watchband would be. Inside this sheath of ligaments is the median nerve. That is the nerve that feeds information to and from your thumb, index finger, middle finger, and the palm of your hand. The narrow space through which these structures pass is known as the carpal tunnel.
Think for a minute about all of the sensory information that comes through your hand and all of the manual dexterity upon which you depend everyday. One of the things that separates humans from the other members of the animal kingdom is the presence of an opposable thumb. Loss of sensation or coordination of the thumb can be very disruptive.
Anything that pressurizes the carpal tunnel may compromise the median nerve. That results in numbness, tingling, loss of muscle strength, and possibly pain everywhere the median nerve goes. We have patients who do not necessarily feel the numbness, but do feel the loss of strength and report to the clinic when they start dropping things.
The carpal tunnel may be the site of some swelling with certain conditions, such as hypothyroidism, rheumatoid disease, diabetes, or even pregnancy. More often the cause is biomechanical: repetitive motion with the wrist flexed. This includes keyboard work, writing, driving, and even repetitive use of a cell phone. This puts a long list of people at risk, such as truck drivers, mechanics, musicians, students, painters, hairdressers, athletes, and people with inflammatory conditions.
Another frequent cause of this condition is a misalignment of one of the tiny bones in the wrist. It is half-moon shaped and aptly named the “lunate” bone. Sometimes this bone squeezes the median nerve and exacerbates or even causes carpal tunnel syndrome. A simple adjustment of the wrist does the trick with immediate relief of symptoms and recovery of full muscle strength.
Besides adjustment of the carpal bones, there are many other treatment options in our bag. Sometimes we have success using infrared lasers that this condition. To the extent that there is inflammation and swelling, this can yield great relief.
The carpal tunnel can also be decompressed. Using the same spinal decompression system that we use for next and backs, we can mechanically decompress the carpal tunnel. This takes about 10 minutes, but it has lasting effects.
A more difficult, but very necessary part of the treatment of this condition is modification of work style. Many of us do things their hands without ever thinking about them, so changing the way we use them can be difficult. It could be as simple as consciously sharing workload between your hands (for example, a right-hander learning to do some things left-handed to give the dominant side some relief). It might mean using other technology, such as electric screwdrivers for the carpenter or mechanic. The keyboardist may need a wrist support designed to keep the wrist straight when working on the computer. For a driver, it might mean holding the steering wheel differently. Ergonomic conditions in which we work every day are important and must be examined closely.
Many of us sleep with our wrists flexed. To prevent this subconscious habit from exacerbating the problem, we use carpal tunnel braces. They wrap around the wrist using Velcro and tilt the wrist about 5° into extension. You can wear these can still use your hand, so you can still scratch where it really inches, but you will keep your wrist in a more restful position.
A few of the worst of these cases may need surgical intervention. As with all surgery, it is a last resort after conservative care and lifestyle changes have not corrected the problem.
The testing for carpal tunnel syndrome is quick and easy. The treatment is quick and easy, and conservative care is very successful. So if you or someone you know has this issue, get it checked out. Hands are important. Take care of them so you can always scratch where it itches.