
Many people believe they have carpal tunnel syndrome (CTS). The
majority have been told by their medical doctor that they have CTS.
Others have mistakenly concluded that because they have some numbness
and tingling in their wrist or hand, they must have this neurological
disorder. Still others have ongoing forearm, wrist, or hand pain
(possibly localized to the thumb and/or index finger), and are led by
articles they've read on the Internet to diagnose themselves with CTS.
Almost all of this is in error.
1,2
Why are so many diagnoses of this condition mistaken? The primary
culprit is lazy clinical decision-making, compounded by a failure to
understand correctly the workings of the musculoskeletal system. Carpal
tunnel syndrome is a specific diagnosis which involves mechanical
pressure on the median nerve as it passes through a small tunnel in the
wrist created by tiny adjoining bones. There's not much room in this
carpal tunnel and its dimensions can be narrowed further by inflammatory
conditions such as osteoarthritis or rheumatoid arthritis. Pregnancy
can lead to CTS owing to increased fluid retention. Repetitive stress
may lead to inflammation of tendons that cross the wrist. Such
inflammation may lead to soft tissue swelling which compresses the
carpal tunnel, causing CTS. Various other disorders should also be
considered when CTS is suspected.
Importantly, CTS is not a catchall diagnosis to be used when a
person has forearm, wrist, and/or hand pain. If a person really has CTS,
he or she will have specific symptoms. The person will awaken at night
owing to pain and/or numbness and tingling. Symptoms will be precisely
located to the thumb and index finger (possibly involving the middle
finger). Wrist pain may or may not be present. Also, the person will
demonstrate a weakness of pinch grip involving the thumb and index
finger. If these signs and symptoms are not present, the person does not
have carpal tunnel syndrome. Usually, the diagnosis is clearcut and
does not require special tests such as electromyography.
Remarkably, most physicians, regardless of specialty, are unaware
of these important criteria. If the patient has pain and/or numbness in
the hand, the patient has CTS. Case closed. This lack of sophistication
leads to real harm done to the patient, such as unnecessary tests which
waste time, cost a lot of money, and may result in damaging surgery
which is not curative as it was directed at a problem that really wasn't
there.
In marked contrast, chiropractors are highly trained in accurate
analysis of musculoskeletal problems involving the shoulder, arm, and
hand.3 When patients have symptoms mimicking those of carpal
tunnel syndrome, chiropractors use their broad knowledge and experience
to correctly evaluate the situation. For example, spinal dysfunction,
muscle spasm, and trigger points can all cause symptoms which appear to
be those of CTS. Chiropractors are able to see through this masquerade
and effectively address the real underlying problems.
Many musculoskeletal problems, including symptoms masquerading as
carpal tunnel syndrome, are effectively managed by chiropractic care.
The key, as always, lies in accurate evaluation of the cause of the
patient's pain patterns.
To a very large extent, physical pain involving the spine,
arms, and legs is related to mechanical joint dysfunction. There are
exceptions, of course, including pain caused by a severe acute injury or
an inflammatory condition such as ankylosing spondylitis. But in most
cases, chiropractic care will provide a solution to a person's
musculoskeletal pain, resulting in a reduction or even a resolution of
the problem.
It's important to remember that most painful symptoms don't
just happen on their own. Your chiropractor will do more than address
the problem at hand. He or she may also help you design an effective
exercise program and a healthful nutrition plan to optimize your health
and well-being over the long-term.
1Ibrahim I, et al: Carpal tunnel syndrome. Review of the recent literature. Open Orthop J 6:69-75, 2012
2Uchiyama S, et al: Current concepts of carpal tunnel
syndrome: pathophysiology, treatment, and evaluation. J Orthop Sci
15(1):1-13, 2010
3Bialosky JE, et al: Heightened pain sensitivity in
individuals with signs and symptoms of carpal tunnel syndrome and the
relationship to clinical outcomes following a manual therapy
intervention. Man Ther 16(6):602-608, 2011