Medical - Carpal Tunnel Therapy
|
   |
Description
Concentrating specifically on the hands and the tendons, ligaments and
muscles of the fore-arm and wrist, this modality provides relief from pain
allowing a gradual return of functionality of the affected areas of the
wrist and hands.
This therapy specifically concentrates on the recommended osteopathic
manipulation and weight loading aspects of the treatment regime for Carpal
Tunnel Syndrome.
Key Benefits
- Improves Flexibility of affected areas
- Promotes Healing
- Promotes Muscle Recovery
Treatment Data
Please read this additional information about Carpal Tunnel
Syndrome...
Author/s: Belinda Rowland
Definition
Carpal tunnel syndrome is a disorder caused by compression at the wrist
of the median nerve supplying the hand, causing numbness and tingling.
Description
The carpal tunnel is an area in the wrist where the bones and ligaments
create a small passageway for the median nerve. The median nerve is
responsible for both sensation and movement in the hand, in particular the
thumb and first three fingers. When the median nerve is compressed, an
individual's hand will feel as if it has "gone to sleep."
Women between the ages of 30 and 60 have the highest rates of carpal
tunnel syndrome. Research has demonstrated that carpal tunnel syndrome is a
very significant cause of missed work days due to pain. In 1995, about $270
million was spent on sick days taken for pain from repetitive motion
injuries.
Causes & symptoms
Compression of the median nerve in the wrist can occur during a number of
different conditions, particularly those conditions which lead to changes in
fluid accumulation throughout the body. Because the area of the wrist
through which the median nerve passes is very narrow, any swelling in the
area will lead to pressure on the median nerve. This pressure will
ultimately interfere with the nerve's ability to function normally.
Pregnancy, obesity, arthritis, certain thyroid conditions, diabetes, and
certain pituitary abnormalities all predispose to carpal tunnel syndrome.
Other conditions which increase the risk for carpal tunnel syndrome include
some forms of arthritis and various injuries to the arm and wrist (including
fractures, sprains, and dislocations). Furthermore, activities which cause a
person to repeatedly bend the wrist inward toward the forearm can predispose
to carpal tunnel syndrome. Certain jobs which require repeated strong wrist
motions carry a relatively high risk of carpal tunnel syndrome. Injuries of
this type are referred to as "repetitive motion" injuries, and are more
frequent among secretaries who do a lot of typing, people working at
computer keyboards or cash registers, factory workers, and some musicians.
Symptoms of carpal tunnel syndrome include numbness, burning, tingling,
and a prickly pin-like sensation over the palm surface of the hand, and into
the thumb, forefinger, middle finger, and half of the ring finger. Some
individuals notice a shooting pain which goes from the wrist up the arm, or
down into the hand and fingers. With continued median nerve compression, an
individual may begin to experience muscle weakness, making it difficult to
open jars and hold objects with the affected hand. Eventually, the muscles
of the hand served by the median nerve may begin to grow noticeably smaller
(atrophy), especially the fleshy part of the thumb. Untreated, carpal tunnel
syndrome may eventually result in permanent weakness, loss of sensation, or
even paralysis of the thumb and fingers of the affected hand.
Diagnosis
The diagnosis of carpal tunnel syndrome is made in part by checking to
see whether the patient's symptoms can be brought on by holding his or her
hand with the wrist bent for about a minute. Wrist x rays are often taken to
rule out the possibility of a tumor causing pressure on the median nerve. A
physician examining a patient suspected of having carpal tunnel syndrome
will perform a variety of simple tests to measure muscle strength and
sensation in the affected hand and arm. Further testing might include
electromyographic or nerve conduction velocity testing to determine the
exact severity of nerve damage. These tests involve stimulating the median
nerve with electricity and measuring the resulting speed and strength of the
muscle response, as well as recording the speed of nerve transmission across
the carpal tunnel.
Treatment
Carpal tunnel syndrome is initially treated with splints, which support
the wrist and prevent it from flexing inward into the position that
exacerbates median nerve compression. Some people get significant relief by
wearing such splints to sleep at night, while others will need to wear the
splints all day, especially if they are performing jobs which stress the
wrist.
The activity which caused the condition should be avoided whenever
possible. Also, the actions of making a fist, holding objects, and typing
should be reduced. The patient's work area should be modified to reduce
stress on the body. This may be achieved by correct positioning and with
ergonomically designed furniture. Performing hand and wrist exercises
periodically throughout the day can be beneficial.
Researchers found that the carpal ligament can be lengthened or released
without surgery through osteopathic manipulation and weight loading.
Combining the two gave additional benefit because manipulation lengthens the
ligament at one end and weight loading increases the length at the other
end. Patients can be taught a stretching exercise for self-manipulation of
the ligament.
A National Institute of Health (NIH) panel concluded that traditional
acupuncture may be a useful alternative or complementary treatment for
carpal tunnel syndrome. Studies have shown that both laser acupuncture and
microamp transcutaneous electrical nerve stimulation (TENS) can
significantly reduce the pain associated with carpal tunnel syndrome. Both
of these therapies are painless. Greater than 90% of the patients treated
reported no pain or pain that had been reduced by more than half. Patients
in this study were also using Chinese herbal medicines, deep acupuncture
(including needle acupuncture), moxibustion, and omega-3 fish oil capsules.
All patients were able to return to work and the pain of most patients
remained stable for up to two years. Persons over the age of 60 years had a
poorer response.
Some studies have shown that persons with carpal tunnel syndrome are
deficient in vitamin B6 (pyridoxine) and that supplementation with this
vitamin is beneficial. Carpal tunnel syndrome should improve within two to
three months by taking 100 mg three times daily. The patient should consult
with his or her physician when taking high doses of this vitamin.
Chinese and homeopathic remedies include:
- arnica; 30c dose
- astra essence
- Rhus toxicodendron; 6c dose
- Ruta graveolens; 6c dose
Allopathic treatment
Ibuprofen or other nonsteroidal anti-inflammatory drugs may be prescribed
to decrease pain and swelling. Diuretics may be used if the syndrome is
related to the menstrual cycle. When carpal tunnel syndrome is more
advanced, steroids may be injected into the wrist to decrease inflammation.
The most severe cases of carpal tunnel syndrome may require surgery to
decrease the compression of the median nerve and restore its normal
function. Such a repair involves cutting that ligament which crosses the
wrist, thus allowing the median nerve more room and decreasing compression.
This surgery is done almost exclusively on an outpatient basis and is often
performed without the patient having to be made unconscious. Careful
injection of numbing medicines (local anesthesia) or nerve blocks (the
injection of anesthetics directly into the nerve) create sufficient numbness
to allow the surgery to be performed painlessly, without the risks
associated with general anesthesia. Recovery from this type of surgery is
usually quick and without complications.
Expected results
Without treatment, continued pressure on the median nerve puts the
patient at risk for permanent disability in the affected hand. Alternative
medicines have been shown to reduce pain. Most people are able to control
the symptoms of carpal tunnel syndrome with splinting and anti-inflammatory
agents. For those who go on to require surgery, about 95% will have complete
cessation of symptoms.
Prevention
Avoiding or reducing the repetitive motions that put the wrist into a
bent position may help to prevent carpal tunnel syndrome. People who must
work long hours at a computer keyboard, for example, may need to take
advantage of recent advances in ergonomics and position the keyboard and
computer components in a way that increases efficiency and decreases stress.
Early use of a splint may also be helpful for persons whose jobs put them at
risk of carpal tunnel syndrome.
Key Terms
- Carpal tunnel - A passageway in the wrist, created by the bones and
ligaments of the wrist, through which the median nerve passes.
- Electromyography - A type of test in which a nerve's function is
tested by stimulating a nerve with electricity, and then measuring the
speed and strength of the corresponding muscle's response.
- Ergonomic - The science relating to a person and his/her work which
strives for the efficient use of human energy.
- Median nerve - A nerve which runs through the wrist and into the hand.
It provides sensation and some movement to the hand, the thumb, the index
finger, the middle finger, and half of the ring finger.
Further Reading
For Your Information
Books
Asbury, Arthur K. "Carpal Tunnel Syndrome." In Harrison's Principles of
Internal Medicine. edited by Anthony S. Fauci, et al. New York: McGraw-Hill,
1998.
Crouch, Tammy. Carpal Tunnel Syndrome and Repetitive Stress Injuries.
Berkeley, CA: Frog, 1995.
Periodicals
Branco, Kenneth, and Margaret A. Naeser. "Carpal Tunnel Syndrome:
Clinical Outcome After Low-Level Laser Acupuncture, Microamps Transcutaneous
Electrical Nerve Stimulation, and Other Alternative Therapies-An Open
Protocol Study." The Journal of Alternative and Complementary Medicine. 5
(1999):5-26.
Brody, Jane E. "Experts on Carpal Tunnel Syndrome Say that Conservative
Treatment is the Best First Approach." The New York Times. 119 (February 28,
1996): B9+.
"Carpal Tunnel Syndrome." Postgraduate Medicine. 98 no. 3 (September
1995): 216.
Glazer, Sarah. "Repetitive Stress Injury: A Modern Malady." The
Washington Post. 110 (March 12, 1996): WH12.
Lucas, B. "Nonsurgical Technique for Carpal Tunnel Syndrome." Patient
Care. 33(March 15, 1999):12.
Seiler, John Gray. "Carpal Tunnel Syndrome: Update on Diagnostic Testing
and Treatment Options." Consultant. 37 no. 5 (May 1997):1233+.
Organizations
- Association for Repetitive Motion Syndromes. P.O. Box 514, Santa Rosa,
CA 95402. (707) 571-0397.
Source: Gale Encyclopedia of Alternative Medicine. Gale
Group, 2001.
|
