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
tunnel.
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 http://www.olsonchiropracticcenter.com for more information.