We have been providing treatment for Carpal Tunnel Syndrome in San Francisco for over 20 years.Carpal
Tunnel Syndrome (CTS) refers to the median nerve being pinched in a tunnel at
the wrist. As the name implies, “carpal” refers to the 8 small bones in the
wrist that make up the “U” shaped part of the tunnel and “syndrome” means
symptoms that are specific and unique to this condition. As we learned last
month, CTS can be affected by nerve pinches more proximal to the wrist, such as
at the forearm, elbow, mid-upper arm, shoulder or neck. To make matters more
complex, there are two other nerves in the arm that can also be pinched in
different tunnels, and the symptoms of numbing and tingling in the arm and hand
occur with those conditions as well. This is why a careful clinical history,
examination, and sometimes special tests like an EMG/NCV (electromyogram/nerve
conduction velocity) offer the information that allows for an accurate
diagnosis of one or more of these “tunnel syndromes” in the “CTS” patient.
Let’s look at these different tunnels and their associated symptoms, as this
will help you understand the ways we can differentiate between these various
syndromes or conditions.
Let’s start at the . There are seven cervical
vertebrae and eight cervical spinal nerves that exit the spine through a small
hole called the IVF (intervertebral foramen). Each nerve, like a wire to a
light, goes specifically to a known location which includes: the head (nerves
C1, 2, 3), the neck and shoulders (C4, 5), the thumb side of the arm (C6), the
middle hand and finger (C7) and the pinky side of the lower arm and hand (C8).
If a nerve gets pinched at the spinal level (such as a herniated disk in the
neck), usually there is numbness, tingling, and/or pain and sometimes, usually
a little later, weakness in the affected part/s of the arm and hand (or
numbness in the scalp if it’s a C1-3 nerve pinch). So, we as chiropractors can
test the patient’s sensation using light touch, pin prick, vibration, and/or
2-points brought progressively closer together until 1-point is perceived and
then comparing it to the other arm/hand. Reflexes and muscle strength are also
tested to see if the motor part of the nerve is involved in the pinch. The exam
includes compression tests of the neck to see if the arm “lights up” with
symptoms during the test.
Next is the . Here, the nerves and blood vessels travel through
an opening between the collar bone, 1st rib and the chest muscles (Pectorals).
As you might think, the nerves and blood vessels can be stretched and pinched
as they travel through this opening and can cause “thoracic outlet syndrome.”
Symptoms occur when we raise the arm overhead. Hence, our tests include
checking the pulse at the wrist to see if it reduces or lessens in intensity as
we raise the arm over the head. At the shoulder, the ulnar nerve is the most
commonly pinched nerve, which will make the pinky side of the arm and hand
numb, tingly, and/or painful. A less common place to pinch the nerves is along
humerus bone (upper arm) by a bony process and ligament that is usually not
there or resulting from a fracture. Here, an x-ray will show the problem.
The is the MOST common place to trap the ulnar nerve in
the “cubital tunnel” located at the inner elbow near the “funny bone” which we
have all bumped more than once. Cubital tunnel syndrome affects the pinky side
of the hand from the elbow down. The median/carpal tunnel nerve can get trapped
here by the pronator teres muscle, thus “pronator tunnel syndrome.” This
COMMONLY accompanies CTS and MUST be treated to obtain good results with CTS
patients. The radial nerve can be trapped at the radial tunnel located on the
outside of the elbow and creates thumb side and back of the hand
Hence, you see the importance of
evaluating and treating ALL the tunnels when CTS is present so a thorough job
is done (which is what Chiropractors do). Try the LEAST invasive approach first
– non-surgical treatment – as it’s usually all that is needed!
We realize you have a choice in who
you consider for your health care provision and we sincerely appreciate your
trust in choosing our service for those needs.
If you, a friend or family member require care for CTS, we would be
honored to render our services.To schedule an appointment with one of our San Francisco Carpal Tunnel Doctors please call 415-392-2225.