Carpal Tunnel Syndrome, Dry Needling, Graston and Other Chiropractic Treatments

Carpal Tunnel Syndrome (CTS) is the most commonly diagnosed disabling condition of the upper extremities (arms). CTS can drastically decrease your quality of life, interfering with sleep, productivity at work, focus, and taking away from the enjoyment of leisure activities. This condition is so chronic in nature that it can also have a negative impact on your mood. People with CTS suffer from chronic numbness and/or tingling in the hands, loss of grip strength and dexterity, forearm discomfort, difficulty finding a comfortable sleeping position due to numbness and tingling, and often have discomfort on the head and neck.

“True” carpal tunnel syndrome is defined as compression of the median nerve in the carpal tunnel. The carpal tunnel is your wrist. The wrist bones and the flexor retinaculum create the walls of this tunnel. Within that you have 10 tendons, synovial sheaths, and the median nerve. Chronic compression of the median nerve is what creates carpal tunnel syndrome. Nerves are responsible for sensations such as pain, light touch, vibration, and proprioception. They need good traffic. In this way, they are like blood vessels; if you compress them, the blood cannot circulate. Your member falls asleep and turns blue. If you compress a nerve, it has a very difficult time transmitting neurological information. This can result in pain, numbness, weakness, tingling, etc. To restore neurological flow, compression must be removed.

Since we’re talking about carpal tunnel syndrome, it should be obvious: compression occurs at the wrist. Yes, this is usually part of the compression, but most of the time the compression is not solely from the wrist. You may have compression from various places throughout your neck and arm, all creating and aggravating the compression. You may also have inflammation of the tissues that create the actual compression within the wrist.

Most of the time, people with carpal tunnel type symptoms do not just have compression of the median nerve. There are 5 main nerves that are derived from the brachial plexus; (1) axillary, (2) musculocutaneous, (3) median, (4) ulnar, and (5) radial. These nerves begin in the neck, branch through the arms, and some continue to the fingers.

The median nerve is the only nerve that passes through the carpal tunnel, but the other four nerves can also contribute to these types of shoulder and arm symptoms. Technically, this diagnosis becomes nerve entrapment and not just carpal tunnel. With true carpal tunnel, symptoms involve the tips of the first three and a half fingers, as well as the corresponding palmar side of the hand. You can see the sensory distributions of the nerves in the following image.

According to American Family Physician, the most common cause of carpal tunnel syndrome is repetitive maneuvers. This includes fine motor activities such as typing, manual labor (hammering, using screwdrivers), etc.

Self-care and Prevention:

If you work in one of these jobs, some practices to help prevent nerve entrapment syndromes include:

Self massage. We recommend using a medium to hard tennis or lacrosse ball to massage the muscles in the hands, arms and shoulders.

Regular forearm and shoulder stretch.

Exercises to counter a rolled forward posture. That is, the strengthening of the muscles of the back and core. If you don’t know where to start in the gym, we highly recommend finding a physical therapist or personal trainer who will show you some great exercises.

Treatment Options:

As in any inflammatory process, we have to eliminate the irritant. Before any type of repetitive injury, rest is indicated in the acute phases. This may even require time off from work. If rest is not possible, Rocktape or Kinesiotape can help with circulation, neuromuscular retraining, and pain. Orthotics can also be useful at work to help keep your wrist in a better ergonomic position. Supplementing with strong anti-inflammatory compounds like turmeric helps dampen internal inflammation and acts as a pain reliever. However, neither of these options is a cure.

Over time, with repetitive type injuries and inflammation, you begin to develop fibrosis in the tissues that creates friction. To restore tissue health, they need treatment along with personal care. In our office, we often use chiropractic manipulation, dry needling, Graston or Gua Sha, myofascial release, cupping, and postural retraining exercises. All of these therapies help restore tissue and fascia and eliminate friction through the different phases of healing. Deep tissue massage, Rolfing, and the like are other excellent therapies to restore tissue.

In cases where acute trauma was involved, such as a wrist fracture that changed bone structure, or arthritic bone changes such as osteophyte formation, conservative treatment may not be enough. In these cases surgery may be the best option. Regardless, it’s still a good idea to give conservative therapy a try. Chances are, you can greatly improve your symptoms.