Newsletter Library, Back, Body & Joint Pain
Many people believe they have carpal tunnel syndrome (CTS). The majority have been told by their medical doctor that they have CTS. Others have mistakenly concluded that because they have some numbness and tingling in their wrist or hand, they must have this neurological disorder. Still others have ongoing forearm, wrist, or hand pain (possibly localized to the thumb and/or index finger), and are led by articles they've read on the Internet to diagnose themselves with CTS. Almost all of this is in error.1,2
Why are so many diagnoses of this condition mistaken? The primary culprit is lazy clinical decision-making, compounded by a failure to understand correctly the workings of the musculoskeletal system. Carpal tunnel syndrome is a specific diagnosis which involves mechanical pressure on the median nerve as it passes through a small tunnel in the wrist created by tiny adjoining bones. There's not much room in this carpal tunnel and its dimensions can be narrowed further by inflammatory conditions such as osteoarthritis or rheumatoid arthritis. Pregnancy can lead to CTS owing to increased fluid retention. Repetitive stress may lead to inflammation of tendons that cross the wrist. Such inflammation may lead to soft tissue swelling which compresses the carpal tunnel, causing CTS. Various other disorders should also be considered when CTS is suspected.
Importantly, CTS is not a catchall diagnosis to be used when a person has forearm, wrist, and/or hand pain. If a person really has CTS, he or she will have specific symptoms. The person will awaken at night owing to pain and/or numbness and tingling. Symptoms will be precisely located to the thumb and index finger (possibly involving the middle finger). Wrist pain may or may not be present. Also, the person will demonstrate a weakness of pinch grip involving the thumb and index finger. If these signs and symptoms are not present, the person does not have carpal tunnel syndrome. Usually, the diagnosis is clearcut and does not require special tests such as electromyography.
Remarkably, most physicians, regardless of specialty, are unaware of these important criteria. If the patient has pain and/or numbness in the hand, the patient has CTS. Case closed. This lack of sophistication leads to real harm done to the patient, such as unnecessary tests which waste time, cost a lot of money, and may result in damaging surgery which is not curative as it was directed at a problem that really wasn't there.
In marked contrast, chiropractors are highly trained in accurate analysis of musculoskeletal problems involving the shoulder, arm, and hand.3 When patients have symptoms mimicking those of carpal tunnel syndrome, chiropractors use their broad knowledge and experience to correctly evaluate the situation. For example, spinal dysfunction, muscle spasm, and trigger points can all cause symptoms which appear to be those of CTS. Chiropractors are able to see through this masquerade and effectively address the real underlying problems.
1Ibrahim I, et al: Carpal tunnel syndrome. Review of the recent literature. Open Orthop J 6:69-75, 2012
2Uchiyama S, et al: Current concepts of carpal tunnel syndrome: pathophysiology, treatment, and evaluation. J Orthop Sci 15(1):1-13, 2010
3Bialosky JE, et al: Heightened pain sensitivity in individuals with signs and symptoms of carpal tunnel syndrome and the relationship to clinical outcomes following a manual therapy intervention. Man Ther 16(6):602-608, 2011