Carpal tunnel syndrome (CTS) is caused by mechanical compression of the median nerve within the carpal tunnel. This compression causes local ischemia and results in sensory and/or motor deficits in the distribution of the median nerve.
CTS is the most common nerve entrapment with a reported prevalence of 3-16% in the general population. (1,2,32,87,118) The condition has a female to male ratio of at least 2 or 3:1. (3,4,34,95) However, the size of the inner structures of the CT are in proportion to that of the CT itself in both sexes. These findings suggest that the etiology of CTS seems to be primarily related to workload and personal traits. (131) The peak incidence of CTS is adults age 45-60. (5,87) White adults are affected 2-3 times more commonly than black adults. (6)
Median nerve irritation can occur from a variety of etiologies and multiple risk factors are often present. Extrinsic factors are often task-related and include prolonged wrist flexion or extension, repetitive wrist movements i.e. supermarket checker, increased hours of smartphone use and extended exposure to vibration or cold. (7,8,100, 130) Those working on an assembly line are at much higher risk for developing CTS than data entry personnel. (9) CTS is rare in developing countries as repetitive work environments are uncommon. CTS is more common in the dominant hand and bilateral symptoms are not unusual. (9,145,146) The patients with CTS revealed less mobility of the median nerve and the mobility of the median nerve could be regarded as a potential CTS marker. (149)
In addition to age, race, and gender, intrinsic risk factors for CTS include: diabetes (119), exposure to contact and ambient cooling (136), hypothyroidism, rheumatoid arthritis, alcoholism, increased BMI (especially recent increases), vitamin D deficiency, renal disease, a thickened transverse ligament, a square wrist ratio and short stature. (10,53,65,71,88,95,99,104,113,139) In more severe cases of CTS the most significant intrinsic risk factors were Vitamin B12 deficiency and an increased BMI. (124) Prior trauma resulting in fracture, dislocation, or osteoarthritis may narrow the canal. Fluid retention during pregnancy is a cause of transient CTS symptoms. (84) Imbalanced tension on the surrounding interconnected fascia limits median nerve displacement and is a suspected etiological mechanism for CTS. (75)
Possessing a “square-shaped wrist”, defined as the ratio of the wrist thickness to the wrist width >0.7 (Johnson’s Index), is a predisposing factor for CTS that shows a progressive correlation with the severity of symptoms. (63) There appears to be a genetic susceptibility that is partially explained by the fact that many of the other risk factors are inherited. Median nerve mobility has been shown to be reduced with CTS. (147)
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What we do in our office to help this condition:
1. Perform a detailed exam, assessing the alignment of the spine, shoulder, elbow, wrist, and small bones of the hand. Because the nerves exiting the spine from the neck branch off and go all the way down to our fingers, improper alignment in any of these areas may be detrimentally affecting the function of the carpal tunnel region, and compromising its ability to function normally.
2. As indicated, adjust areas of subluxations (misalignments), restoring proper alignment and nerve system function, which facilitates healing. It is common to find subluxated bones in the neck, arm, wrist, and/or hand when someone is experiencing carpal tunnel syndrome.
3. Perform laser therapy which penetrates to the cellular level of the soft tissues surrounding the forearm and wrist. This promotes better oxygen and nutrients to the tissue, which can relieve pain and facilitate the healing process.
4. Prescribe stretches and exercises in conjunction with chiropractic care to strengthen the soft tissue.