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Is it Carpal Tunnel Syndrome or Something Else?

Posted Apr 07 2013 12:00am
Carpal tunnel symptoms treatment SF Carpal Tunnel SYMPTOMS are a common group of complaints presented to chiropractic offices. Symptoms like arm pain, wrist and hand pain, elbow pain, night pain in the hand, weakness, loss of grip strength, numbness, tingling, loss of normal sensations in the arm and hands, and even neck pain.

Sometimes these symptoms are the result of true Carpal Tunnel Syndrome (CTS) and sometimes they aren't. It's our job to figure out the cause.

Usually, patients with CTS symptoms wait for weeks, months, or even years before seeking care, thus making management more challenging. The history of the “classic” CTS patient includes a mild, sporadic onset that gradually becomes more frequent and intense. This usually leads to continued problems that start to affect other areas proximal to the hand, such as the elbow, shoulder and/or neck. We usually find that people will compensate during their activities, and instead of moving the wrist and hand to perform a task, they will start to move their elbow and shoulder more to avoid irritating movements of the hand/wrist. Over time, overloading the muscles in these areas can lead to one or more conditions commonly referred to as “cumulative trauma disorder” (CTD), which includes many diagnoses including (but not limited to) tendonitis of the thumb (de Quervain’s Disease), ganglion cysts, tennis elbow (lateral epicondylitis), golfer’s or bowler’s elbow (medial epicondylitis), cubital tunnel syndrome (ulnar nerve pinch at the medial elbow), tunnel of Guyon syndrome (ulnar nerve pinch at the wrist), shoulder tendonitis (biceps, rotator cuff), thoracic outlet syndrome (pinched nerve at the shoulder), and / or neck strain, neck herniated disk, pinched nerve, and/or headaches. Many times, these conditions co-exist if the patient has really abused themselves (such as music majors who may practice playing their instrument for 4-5 hours a day) to a point where they are REALLY injured in multiple areas.

            Limiting this discussion to pinched nerves in the neck and upper limb, the question often arises, “…how do you know where the nerve is pinched?” The answer centers around determining an accurate history to find out  EXACTLY where the patient feels numbness, tingling, weakness, and/or pain as each nerve innervates a different area. For example, if a patient says, “…I feel numbness in my 4th and 5th finger,” this tells us that the ulnar nerve is pinched (as opposed to numbness in the 2nd, 3rd, or 4th fingers which suggests median nerve pinch -- more classic of CTS). If the patient says the numbness affects the arm from the elbow down to the 4th and 5th finger, this suggests cubital tunnel syndrome (ulnar nerve pinch at the medial elbow). If the numbness affects the person from the shoulder to the 4th and 5th finger, thoracic outlet syndrome becomes a probable diagnosis. And lastly, if the neck, shoulder, arm and hand (on the pinky side) are numb, we are suspicious of a pinched nerve in the neck.

            Then, we confirm our suspicions with a more detailed physical examination. Here, we test for compression of a nerve at the neck by positioning the head in a backwards, rotated position and holding it for about 10 seconds to see if the numbness is reproduced. We can also manually (with our hands/fingers) compress the various nerve pathways to see if numbness occurs at the front of the neck, the shoulder under the collar bone, at the elbow and wrist counting the seconds to time the onset of numbness and mapping the numbness location. Placing the shoulder, elbow, and wrist in different positions can pinch the nerve as well, and mapping the location of the numbness tells us where and to what degree the nerve is pinched.

We will also perform a neurological exam testing reflexes and strength, as well as sensory function using a sharp object. A special test called an EMG/NCV (electromyography and nerve conduction velocity) can be obtained to further verify the location and degree of nerve pinching and damage. At our San Francisco Back, Neck, and Wrist Pain Center we first try conservative treatment before ordering nerve tests or MRI.

            The advantage of chiropractic management is that we will treat EVERY LOCATION that may be contributing to the CTS symptoms, whether the pinch is in the neck, shoulder, elbow and/or wrist. Managing the WHOLE PERSON, not just the wrist or CTS is KEY to a successful outcome. And we can do this in a very short period of time. We can adjust from the neck to finger tips on both sides in a matter of minutes. We also have tools such as deep tissue laser therapy that can help speed the healing process as well as advanced soft tissue treatments such as Graston Technique .

            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 a carpal tunnel doctor in San Francisco please call 415-392-2225 and ask for a complimentary consultation.


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