Do you experience tingling or numbness in your hands and fingers?  Maybe it feels like sharp pins and needles, or perhaps you experience burning feelings in your hands, wrists, and even forearms.  Perhaps your symptoms are worse at night, or you wake up with numb hands in the morning.

Sometimes it is a minor annoyance that is shaken off –a brief flick or shake of the hands can help the sensations disappear or go away before continuing your daily routine. 

However, if left unaddressed and untreated, these symptoms may slowly progress and worsen to a point where holding a bagel causes sharp, shooting feelings into your fingers, or picking up and holding a stylus for a tablet is painfully frustrating.  You may even experience a loss of grip strength or start dropping your phone or car keys more often.

If this describes you, you may have carpal tunnel syndrome.  Carpal tunnel syndrome often feels like numbness or uncomfortable sensations in your hands and wrists, particularly with your thumb, pointer, and middle fingers.

But what is carpal tunnel syndrome?  To answer the question, we must first understand the structures involved with the condition: the carpal tunnel.

Read more about carpal tunnel syndrome here: https://my.clevelandclinic.org/health/diseases/4005-carpal-tunnel-syndrome

 

What is the Carpal Tunnel, and How is it Injured?

Think of a mountain blocking the path of a train.  Rather than spend additional time plotting a course to weave around the mountain, a tunnel is built for the train to move through it.  That tunnel is the carpal tunnel; it is the transition area where the wrist becomes the hand.  It consists of a series of small bones in a U-shape in the wrist with a ligamentous band creating the “roof” of the mountain tunnel. 

What train runs through the carpal tunnel?  That would be the many ligaments, nerves, tendons, and vascular structures that supply mobility and strength to the hand.  These structures run the length of the carpal tunnel and allow the wrist to flex, extend, and deviate from side to side without pain.  These structures also allow the fingers to flex and extend, bend, grip objects, and supply sensations and tactile information to the brain. 

However, like other parts of the body, compromise and injury can occur in the tunnel area of the wrist.  Inside the carpal tunnel is a specific nerve known as the median nerve, which supplies sensation to the palm side of the hand and the first 3 ½ fingers. 

Compression of the median nerve creates carpal tunnel syndrome symptoms.  Carpal tunnel syndrome is the most common entrapment neuropathy of the upper extremity, hands, and wrists, affecting people who use their hands for a living.  Carpal tunnel syndrome affects approximately 3% of the population!

Symptoms of carpal tunnel syndrome can come on suddenly or gradually.  Different injuries affect the integrity of the carpal tunnel in different ways; as such, carpal tunnel syndrome is associated with both trauma and repetitive activity. 

Acute injuries can damage or tear ligaments and tendons, fracture bones, create inflammation, cause swelling, and compress or pinch the nerve directly.  Repetitive injuries, such as working an assembly line, grasping a steering wheel to drive, or typing on a keyboard, can cause injury to the carpal tunnel by creating tendinopathy or inflammation of the tendons that run the span of the carpal tunnel.  These irritated, inflamed tendons cause swelling and other mechanical problems in the wrist, including carpal tunnel syndrome.

Space-occupying tumors, using construction equipment and vibrational tools, and pregnancy can also contribute to the development of carpal tunnel syndrome.

Because the bony tunnel is narrow with little room for expansion or flexibility, injury and inflammation create a painful condition that can be slow to heal.  Here is a link to read more about carpal tunnel:

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Carpal-Tunnel-Syndrome-Fact-Sheet

 

Symptoms of Carpal Tunnel

The probability of injury occurring to the wrist and median nerve is high because of our reliance on our hands to perform everyday activities.  And it frequently affects both hands, although carpal tunnel syndrome is more common in your dominant hand.

Symptoms experienced during carpal tunnel syndrome include:

  • Hands feeling swollen and tight.
  • “Dead hand” sensation.
  • Tingling and numbness: Pressure on the median nerve creates tingling sensations and/or numbness that extend into the thumb, pointer, middle finger, and half of your ring finger of your affected hand.  The pinky finger is rarely involved.
  • Sharp, burning, or dull achy pain along the palm and fingers.
  • Decreased feeling in the fingertips.
  • Electric-like shooting feelings in your wrist, fingers, and/or forearm.
  • Weakness of the hand muscles due to diminished blood flow and nerve impingement.  The thumb’s pinching muscles are controlled by the median nerve.
  • Shoulder pain: Pain can radiate or travel up the arm and into the shoulder.
  • Nighttime or morning symptoms: Some patients report the pain is worst at night at bedtime or when first waking up in the morning.

Because many wrist injuries are from overuse or trauma, carpal tunnel syndrome can occur with other associated conditions such as sprains, strains, muscle and ligament tears, contusions, wrist and hand fractures, tendinitis/tendinopathies, forearm injuries, and more.

Who is at risk for developing Carpal Tunnel Syndrome?

Carpal tunnel syndrome most often affects adults age 45-60, occurring two or three times more frequently in women than in men.

You could be at higher risk of developing carpal tunnel.  Some activities and conditions have an inherent more significant risk of developing carpal tunnel syndrome.  These include:

  • Diabetes, thyroid conditions, and hemodialysis;
  • Pregnancy;
  • Wrist fracture or wrist dislocation;
  • Hand or wrist deformity;
  • Arthritic diseases such as rheumatoid arthritis and gout;
  • Forceful, repetitive movement such as construction and carpentry;
  • Any activity typically related to excess or repeated stress on the wrist;
  • Sleeping ergonomics that result in the wrist being flexed or bent;
  • Sports and activities with repetitive hammering motions.

 

Even individuals who do not engage in higher-risk activities may still develop carpal tunnel syndrome if they have poor conditioning, hereditary factors (carpal tunnel can run in families), poor ergonomics with prolonged flexion of the wrist, extreme wrist motions, and use of vibrational tools like video game controllers and construction equipment.

Pregnancy and the natural hormone fluctuations associated with proper fetal development may cause fluid retention, resulting in decreased space in the carpal tunnel for nerves and tendons to move.

Is wrist pain always Carpal Tunnel Syndrome?

Sometimes not.  Although a patient may present with tingling, pain, and discomfort in the hands and fingers, further investigation and examination should determine if there is another cause.

X-rays can reveal if there is an osseous anomaly, bone disease, or fracture causing symptoms.

If there is nerve involvement such as extensive weakness or muscle wasting and loss of grip strength, tingling, or numbness into the hand and fingers, an evaluation may be done to evaluate nerves for prolonged neuropathy and impingement.  Electrodiagnostic studies include nerve conduction studies and electromyography to determine the nerve's integrity to transmit nerve impulses to the muscles of the hand.

Other conditions that should be ruled out when considering carpal tunnel syndrome include DeQuervain’s tendinosis, trigger finger, pronator syndrome of the forearm, and arthritis.

 

How do you manage Carpal Tunnel Syndrome?

Because the nature of this injury is usually repetitive or acute, addressing ergonomics and making changes to movement becomes an imperative part of an effective treatment plan.

A person with carpal tunnel syndrome doesn’t have to stop their daily routine or their job.  Management of carpal tunnel syndrome will depend on whether the condition is caused by acute trauma, repetitive use, or if there is another contributing condition such as diabetes or pregnancy.

Approaches to treatment range from conservative to invasive.  Management depends on the severity of the symptoms and the ability to continue performing usual activities of daily living.

Conservative care may include specific stretches for muscles and tendons of the forearm and wrist, carpal bone mobilization, therapeutic ultrasound, targeted soft tissue work into the muscles and fascia, nocturnal splinting of the wrist, or using a specific brace to keep the wrist extended, making ergonomic changes at work or home, nerve glide exercises, and more.

More invasive forms of care may include local corticosteroid injections and surgical decompression.  These interventions can be helpful and necessary for severe forms of carpal tunnel syndrome. 

 

How we treat Carpal Tunnel Syndrome

In our Boca Raton Sports Chiropractic practice, we take a detailed history of your injury and perform a thorough examination of your wrist and hand movements, assess any tingling or loss of tactile sensation, evaluate grip and hand strength, and more.  Our goal is to not only provide you with the correct diagnosis of your injury but also determine the underlying root cause of your injury and create an individualized treatment plan specifically for you.  We have many tools in our toolbox to create an effective evaluation and devise the appropriate treatment. 

We may analyze your daily ergonomics and habits to determine if lifestyle or activity modifications are necessary.  You may not be able to completely avoid the repetitive wrist strain, flexion, or postural stress that gave you carpal tunnel in the first place – especially if it's part of your job.  However, we may suggest adjustments, for example, by using special devices like wrist braces at night, a raised keyboard or desk at home, steering wheel grips, a cushioned mouse pad for work, and more.  We also prescribe sports rehab exercises, utilize soft tissue approaches including myofascial release work, and have other therapeutic modalities to treat your hand and wrist pain safely and compassionately.

Your treatment plan is unique to you and your condition.  Some approaches we may use to help your wrist pain consists of sports rehabilitation exercises, Active Release Techniques (Muscle Work), chiropractic, Graston Technique®, and deep tissue laser therapy.

Frequently Asked Questions (FAQ)

Can I prevent carpal tunnel syndrome from developing?

If you’re worried about developing carpal tunnel syndrome, we understand!  Thankfully, there are some tips to help prevent injury.  These are:

  • Use the right tool/equipment for the job.  If you’re completing a physical task, be sure to use the tool properly designed to reduce the risk of a wrist injury.
  • Relax your grip and reduce the force used for tasks.
  • Use ergonomic aids.  These include keyboard trays, typing pads, grip cushions, armrests, wrist braces, split keyboards, sleep posture changes, and other ergonomics.
  • Take frequent breaks.  If you’re engaged in the same activity for a prolonged period of time, take a break to stretch, change positions, or perform another task.
  • Keep your hands warm.
  • Stop if you feel tingling or pain.

 

If you need help in determining the best methods for injury prevention, call us!  Chiropractors are trained to treat musculoskeletal injuries from strains/sprains, falls on an outstretched wrist, repetitive use injuries, and the wrist is part of this system. 

Are chiropractors trained to take care of wrist injuries? 

Absolutely.  Chiropractors are known for working on spinal complaints, but their training includes extremity work on the arms and legs.  A chiropractor can treat the initial injury, aid with soft tissue healing, help with rehabilitation, and help the patient with activity modifications to restore proper movement and function.  May patients report feeling better after seeing a chiropractor, some even performing at a higher level than before the injury!  Therefore, it’s important for a treatment plan to not just relieve pain but also help stretch and strengthen the wrist in an effective manner.

Additionally, treating a wrist injury alone may not be enough if the patient unknowingly continues doing whatever caused the injury in the first place.  Part of a comprehensive evaluation and treatment includes education, and our doctors are trained to provide.  Helping you understand your body and how it moves is an important piece to preventing future injury.  Here are some other articles to read regarding treating carpal tunnel syndrome:

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Carpal-Tunnel-Syndrome-Fact-Sheet

https://www.assh.org/handcare/condition/carpal-tunnel-syndrome

When should I see a chiropractor for my wrist pain?

Surgery is not always recommended for carpal tunnel syndrome, and sometimes surgery is performed without pursuing conservative care first.  Although surgical intervention can be helpful, it can also result in iatrogenic complications and side effects such as scarring and non-resolution of symptoms, as well as increased downtime from work and daily lifestyle.  Conservative care is often recommended before pursuing surgery as it can result in a similar outcome without resorting to the scalpel and anesthesia.

A chiropractor can be the first and best line of defense in the conservative management of carpal tunnel syndrome. The chiropractor goes through a screening process to see if they are the best fit for you and your road to recovery or if you need to be referred to another specialist, such as an orthopedist or sports medicine doctor.

If you are dealing with tingling, numbness, and wrist pain, and want a same-day examination and treatment for your injury, call our Boca Raton or Miami chiropractic and sports injury office 561-997-8898 or schedule online.