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Is it really Carpal Tunnel Syndrome?
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Carpal Tunnel Syndrome (CTS) gets a lot of press as being the primary culprit behind wrist pain. But, in fact, there are a number of other diseases, harmful habits, spinal conditions and syndromes that can masquerade as CTS.

Overuse of the wrist may result in carpal tunnel syndrome: inflammation in the carpal tunnel causing entrapment of structures in the tunnel, especially the median nerve. Symptoms of this painful and debilitating condition consist of numbness, tingling and loss of strength in the thumb, index, middle and part of the ring fingers.

Although wrist disorders may strike anyone, certain activities increase risk. Any sustained, repetitive movement stresses the wrist.

Common instigators include assembly work, cashiering, playing video games and keyboarding on a computer. Anyone with a job requiring continuous grip with the hands, such as painters, plumbers, electricians, carpenters and artists are prime candidates.

While CTS is a major health concern, it is not always the direct cause of wrist pain. There are a glut of CTS imposters. That is why it is important for people with wrist problems to consider other possible causes, particularly if they are considering surgery.

Since the median nerve extends from the first three fingers through the carpal tunnel, up the forearm, past the elbow, up the arm, through the shoulder and neck regions, where it branches, goes through openings between vertebrae in the neck and ultimately into the spinal cord at several levels, entrapment may occur not only in the carpal tunnel, but anywhere along its length to the spinal cord. As a result, pain and nerve disturbance may occur anywhere from the fingers to the neck.

Research reveals that problems in the cervical spine (neck) may cause symptoms which can be "confused clinically with carpal tunnel syndrome." (Magn Reson Imaging Clin N Am 1995;3:249-64.)

Small misalignments of cervical vertebrae can cause fixation and localized swelling in the neck that can entrap branches of the median nerve, creating pain and numbness in the wrist and hand.

Bony misalignments of the shoulder, elbow and wrist can also cause swelling that may entrap the median nerve on its way to and from the hand and fingers. In fact, the lunate or capitate bones of the wrist may misalign and "fall" into the carpal tunnel causing pain and numbness.

Chiropractors are very good at safely and gently adjusting the neck to ultimately relieve pressure on the branches of the median nerve. They can adjust the bones of the wrist, shoulder and elbow joints, if they are found to be the cause of impinging the median nerve, as well. If entrapment had occurred in any of these areas, then the result is usually relief of CTS symptoms.

Another CTS imposter may trigger wrist pain: ulnar tunnel syndrome (UTS). Also known as Guyon's canal syndrome, ulnar carpal tunnel syndrome or hypothenar hammer syndrome, UTS results from pressure on the ulnar nerve which is also located in the wrist.

Symptoms are similar to those of CTS and tend to worsen at night (as happens with CTS, as well), but the fingers involved are the little and part of the ring fingers.

Like CTS, UTS has a spinal connection. According to one scientific study, "Lower cervical spine disease sometimes occurs concomitantly with entrapment of the ulnar nerve at the wrist.

This condition, termed the 'double crush injury,' may produce ulnar nerve symptoms that are referred proximally into the upper arm, shoulder, neck and chest wall. In such cases, both the cervical spine and the wrist must be treated." (Am Fam Phys 1991;44:497.)

In addition to chiropractic care, prevention of UTS includes careful handling of tools and use of protective gloves.

Commonly referred to as "tennis elbow" when it occurs laterally and "golfer's elbow" when it occurs medially, epicondylitis is associated with a variety of sports and occupational activities (J Am Acad Orthop Surg 1994;2:1-8). Symptoms of lateral and medial epicondylitis include elbow pain, in addition to weakness in the wrist and fingers (J Ky Med Assoc 1990;88:349).

Nerve entrapment and symptoms associated with CTS can also be brought on by diabetes, smoking, alcohol consumption, rheumatoid arthritis and hypothyroidism: although these disorders typically produce simultaneous symptoms in both arms; not just one (Am Fam Physician 1995;51:103-16).

As always in the wellness paradigm, it may be a good idea to schedule an appointment with your healthcare professional to discuss ways to adjust your work and postural habits to minimize wrist and neck problems before they become sources of pain. w


Karen and Clark Voss have a family wellness chiropractic clinic in Savannah at 5704 Skidaway Rd. Call 356-5886.