Saturday, April 5, 2014

The Many Faces of Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) was first reported in the late 1800’s and the first
surgery was noted in 1933. In the beginning, CTS surgery was rarely performed,
reportedly because the nerve pinch was present somewhere before the median nerve
reached the wrist or carpal tunnel. In brief, possible compression sites include
the cervical nerve roots (C5-7), the brachial plexus, thoracic outlet, above the
elbow, in the proximal and/or mid forearm, and finally at the wrist / carpal
Estimating the frequency of CTS is challenging due to the fact that the pinch or
entrapment may include more than one area before the wrist resulting in double
and multiple crush syndromes. One European study reported the incidence of CTS
at 5.8% in women and 0.6% in men while another reported 3.4% in the United
States. Even the causation of CTS is all over the board. For example, the annual
incidence of CTS in automobile workers ranges between 1-10%, while in a fish
processing plant, it was reported to be as high as 73%! To make this even more
challenging, the cause of CTS is commonly associated with other conditions such
as diabetes and pregnancy. In diabetics, CTS ranges between 14% and 30% and
those who are pregnant have a 2% incidence. Even harder to report is the
incidence of median nerve pinching proximal to the wrist as this ranges between
as little as 1% to as high as 75% for pronator tunnel syndrome in already
symptomatic women. Gender is also a factor as women are reported to be four
times more likely to develop CTS than men. If there is NO other condition
associated with CTS, the term “idiopathic” is applied, and this reportedly
occurs 43% of the time.
Another issue making CTS a challenge to diagnose is the many risk factors
associated with it, and sometimes studies are published that contradict one
another about the possible risk factors. There are studies that report CTS is
more likely to occur with conditions including: 1) Jobs or activities associated
with wrist flexion or extension; 2) Hysterectomy without ovary removal; 3)
Obesity; and 4) Varicosities in men. Some studies indicate risk criteria such
as: 1) Use of birth control pills; 2) Age at menopause; 3) Diabetes; 4) Thyroid
dysfunction; 5) Rheumatism; 6) Typing; and, 7) Pinch grasping. One study
reported the highest incidence to occur in those with previous wrist fracture
(Colles’ fracture), and common conditions included rheumatoid arthritis,
hormonal agents or ovary removal, diabetes, and pregnancy. Another study
reported obesity and hypothyroid as being risk factors, but not all studies
support that theory. Certain medications have been reported to be associated
with higher CTS risk including: 1) Insulin, 2) Sulfonylureas (diabetes meds); 3)
Metformin; and 4) Thyroxin.
As doctors of chiropractic, we perform a thorough history, examination, and
offer MANY non-surgical, non-pharmaceutical ways of treating CTS. Some of these
approaches include: 1) Joint and soft tissue manipulation of the neck, shoulder,
elbow, forearm, wrist, and hand; 2) Wrist splinting, especially at night; 3)
Vitamin B6 and anti-inflammatory nutrients; 4) Home exercises for the neck, arm
and hand; 5) Work station / ergonomic evaluations; 6) Dietary counseling for
various conditions listed previously; 7) Co-management with primary care,
rheumatology, neurology, orthopedics, and others.
We realize you have a choice in whom 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 requires care for Carpal Tunnel Syndrome, we
would be honored to render our services.  Visit for more information.

The "Aging" Lower Back - Part 1

Low back pain (LBP) can arise from many causes. Nearly everyone has or will
suffer from LBP at some point in time, though it is most common in the
30-year-old to 50-year-old group and it affects men and women equally. However,
what about the elderly population and low back pain? Let’s discuss back pain
unique to the geriatric population…
We’ve all heard of the “wear and tear” factor as it applies to clothing,
automobiles, shoes, and tires, but it affects our bones and joints too! A
condition that none of us can fully avoid is called osteoarthritis (OA). OA is
the “wear and tear” factor on our joints, particularly the smooth covering
called hyaline cartilage located on the surfaces of all moving joints. It’s the
shiny, silky smooth surface that we’ve all seen at the end of a chicken leg when
we separate it from the thigh. Osteoarthritis is the wearing away of that shiny,
smooth surface and it can eventually progress to “bone-on-bone” contact where
little to no movement is left in the affected joint. Bone spurs can also occur
and be another potential generator of back pain. OA is NOT diagnosed by a blood
or lab test but rather by an accurate history, physical examination, and
ultimately, an x-ray. However, when the low back is affected by OA, it may not
even hurt! Yes, in some cases, there may be a significant amount of OA on an
x-ray and that patient may not have significant problems. Or the opposite can
occur and some patients with very little arthritis can have a lot of back
trouble. It’s FREQUENTLY very confusing. The “take-home” message with OA is
that, in and of itself, it does not always generate pain. This is why the
history, physical examination, and the response to treatment (chiropractic
adjustments, exercise, and possibly some lifestyle changes in diet and activity)
are MORE important than the amount of arthritis found on the x-rays. Ultimately,
we will ALL get OA sooner or later. It’s usually a slow, gradual process that
may slowly change our activity level. Ironically, KEEP MOVING is the best advice
we can give to the patient with OA.
There are a number of conditions associated with OA that affect the spine and
respond well to chiropractic treatment. Degenerative disk disease (DDD) is one
of those conditions found in association with OA. In fact, another name for OA
is “degenerative joint disease” (DJD)! The normal anatomy of the intervertebral
disk (IVD) consists of a thick, tough outer layer of fibroelastic cartilage and
a central “nucleus” that is more liquid-like and allows the IVD to function like
a shock absorber. As we age, the water content gradually “dries up” and the
shock absorbing quality is lost.
As chiropractors, we address OA (DJD) and DDD with a number of HIGHLY EFFECTIVE
treatments but most important (in many cases) is the use of spinal manipulation
or adjustments. “Exercising the joint” with manipulation and mobilization
reduces the tightness and stiffness associated with OA and DDD. Exercises are
also important and can give the OA/DDD patient a way of controlling this
condition on their own. Diet, activity modification/encouragement, and periodic
adjustments help a lot! Next month, we will continue this discussion!
We realize you have a choice in whom 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 requires care for back pain, we would be
honored to render our services. Visit for more information.