Tunnel Vision

[originally published in KCN, October 1998]

tunnel-vision-1It’s been tagged as the surgery of the decade.  Its prevalence has nearly doubled in the past ten years.  Its gained  recognition as the most common peripheral nerve entrapment neuropathy in the United States.  And more and more workers’ compensation claims are being filed for it.

I’m talking about a condition that is well known to many people — carpal tunnel syndrome.

Interestingly, this condition is relatively new.  No mention of this debilitating syndrome is referred to in the ancient writings of Hippocrates, our father of medicine.  Nor did the medical writers of the middle ages put it down on paper.  It wasn’t until 1880 that it found its place in the pages of the medical volumes.  And as our society motored through the Industrial Revolution and has keyboarded its way into the technology-driven Information Age, this once unknown syndrome has made quite a name for itself.

Anatomically speaking, the carpal tunnel is just what it sounds like.  It’s a tunnel in the wrist,  formed by the carpal (wrist) bones on one side and a taut ligament on the other.  It can be a tight fit, but this tunnel is basically able to accommodate numerous tendons, connective tissues, synovial sheaths, and the very important median nerve.  The tunnel concept is not unique to the wrist.  We have nerves, blood vessels, and other structures, coursing through many different tunnels in our body.  The tarsal tunnel, cubital tunnel, radial tunnel, and Tunnel of Guyon are some that come to mind.  But none has garnered as much attention as the carpal tunnel.

Any condition that reduces the space in this tunnel can spell trouble for its contents — especially the median nerve.  The median nerve is responsible for the majority of the sensations and muscular activity in the hand and wrist.  Classical symptoms of carpal tunnel syndrome are numbness or burning in the htunnel-vision-2and that is often worse at night or when gripping objects.  Weakness and loss of dexterity can show up as well.  As the syndrome progresses, the symptoms get worse.  Pain can radiate up into the forearm and sometimes the shoulder.

While carpal tunnel syndrome has been known to just “show up” in people with certain conditions such as diabetes, rheumatoid arthritis, and pregnancy,  the vast majority of carpal tunnel sufferers are people whose jobs require their wrists to perform repetitive, forceful, and/or extreme positioning everyday:  people such as assembly line workers, keyboard operators, and grocery store clerks.  Mechanics, construction workers, and, yes, even chiropractors demand more force out of their  wrists.  Food servers and  massage therapists often subject their wrists to extreme positions.  All of these jobs  contribute to cumulative microtraumas in the wrist, which can eventually bring about swelling and inflammation in the carpal tunnel.  When all this happens, BINGO — the median nerve gets pinched.

Typical medical management of this condition might involve the wearing of a wrist splint and medications to reduce inflammation.  More aggressive measures would include steroid injections to the offending area.  If all this fails, surgeons can cut the ligamentous portion of the tunnel to relieve the pent up pressure.  For some, this may do the trick, but  for many the relief is short-lived.  Reoccurrence of symptoms  from the accumulation of post-surgical scar tissue and the fact that the cause of the problem was never properly addressed, is all too common.

In order for us to get a handle on this increasing syndrome, we need to look beyond the “tunnel” and take a more global look.   Most cases of carpal tunnel syndromes are a result of a structural misalignment brought on by overworked and overstrained muscles of the arms and hands.  In other words, there is an imbalance in the relative strength of ttunnel-vision-3he forearm muscles that control wrist and hand movements.  If someone performs a repetitive task day in and day out, chances are, only one aspect  of the wrist is working.  What you end up with is a strong muscle on one side and a weak one on the other.  Since both muscles work as a team to maintain the structural integrity of the wrist, you can see how things might get out of alignment, and thus reduce the potential space of the carpal tunnel, bringing on median nerve irritation.  This concept can be likened to a television antenna on a roof top supported by guy wires.  In order for the antenna to stand straight, all the guy wires must be of equal tautness.  If  a strength imbalance greater than 10-15% exists between  two opposing muscles, then the joint that they control (in this case the wrist) has a greater likelihood of injury.  So, if these muscular imbalances can be identified early enough, proper conditioning of the weaker muscles can begin to balance out the strength issue.  Often times this just means learning a few simple home exercises that you can perform when you’re not working.

Another vital aspect of good wrist health, and overall health for that matter, is ergonomics of the workplace.  Ergonomics  focuses on fitting the workstation to the person, not the other way around.   By having the body in correct postural alignment while performing repetitive and prolonged tasks, wear and tear of the joints can be minimized and efficiency can be maximized.

A very important aspect of carpal tunnel syndrome that is hardly ever considered is what is happening to the median nerve before it passes through the carpal  tunnel.  The median nerve begins its journey from the spinal cord, exits out of the neck, through the shoulder, past the elbow, and then through the carpal tunnel to the finger tips.  Problems can develop, and often do, in any one or more of these areas.  Studies, dating back as early as 1973,  have proposed that if a nerve is impaired at one location, it makes that nerve more susceptible to other entrapments along its pathway.  In other words, someone with nerve irritation in the carpal tunnel is much more likely to develop other areas of irritation along the same nerve at points in the neck, shoulder, and/or elbow.  Or the reverse can be true:   someone with a neck problem is more prone to developing problems further down the affected nerve, say the carpal tunnel.  Another study concluded that two low grade compressions along a nerve are worse than either one alone.  If proper healing is to take place, each area of nerve compression or entrapment needs to be identified and treated.

Your doctor of chiropractic can be a valued asset in the prevention and treatment of carpal tunnel syndrome.  After a thorough examination, specific adjustments will be performed where needed to help normalize faulty structure and reduce nerve irritation in the neck, shoulder, elbow, and/or wrist.  Muscular imbalances will be addressed with special soft tissue techniques and specially tailored home stretches and exercises.  Your doctor of chiropractic may include the use of a wrist splint in the beginning of your treatment along with ergonomic advice to encourage the reduction of physical stresses through proper postures.  In addition, nutritional recommendations, such as vitamin B6 supplementation, may be given to enhance the overall health of the median nerve, aiding in the healing process.

Carpal tunnel syndrome is definitely a condition of our own making.  Knowing that the activities that we perform put us at risk is the first step in addressing the problem.  Learning how to reduce our risk through preventative measures is the second step.  The third step, if and when it does occur,  is to avoid the “tunnel vision” of focusing all of our attention on patching up the end result.  Rather, we need to take a step back and look at and address the causative and aggravating factors that brought it on in the first place.  Maybe then, this “surgery of the decade” can become one for the history books and not one for the newspapers.

Your doctor of chiropractic is ready and willing to help.
_________________

Sources used for this article:
Barnard, Neal.  Foods that fight pain.  Harmony Books, New York.  1998.
BenEliyahu, David.  Clinical neurodiagnostics: double crush syndrome.  Dynamic Chiropractic.  04/22/96.
Bergman, Peterson, and Lawrence.  Chiropractic technique.  Churchill Livingston, Inc.  1993.
Carpal tunnel and the chiropractic lifestyle.  Back Talk Systems, Inc.  1997.
Dunphy and Mannello.  Carpal tunnel syndrome.  JACA.  July 1998.
Gatterman, Meridel.  Chiropractic management of spine related disorders.  William and Wilkins, Baltimore.  1990.
Lawrence, Dana (ed).  Year book of chiropractic 1996. (pp. 236-237) Mosby Year Book Inc.  1996.
Montgomery, Kate.  Carpal tunnel syndrome:  prevention and treatment.  Sports Touch Publishing, San Diego.  1994.
Oslay, Theodore.  Carpal tunnel diagnosis denied.  Dynamic Chiropractic. 01/31/90.
Oslay, Theodore.  Carpal tunnel — part one.  Dynamic Chiropractic.  03/28/90.
Oslay, Theodore.  Carpal tunnel — part two.  Dynamic Chiropractic.  04/25/90.
Reyes, Dan.  Physiotherapeutics II.  LACC.  1994.
Schimp, David.  Carpal tunnel syndrome:  a multidisciplinary team approach to industrial work place evaluations. JACA 1997.
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