September 20, 2018

Can a Chiropractor Help Carpal Tunnel Syndrome?

Articles by Dr. Erdman are for informational purposes, and are not to be taken as specific medical advice.

Do you or someone you know have hand pain, numbness or tingling? Have you been diagnosed with carpal tunnel syndrome (CTS)? Do you think surgery is the only answer? I’m writing to give you a different perspective on this pervasive problem.

First we will start with some statistics on the second most common musculoskeletal surgery (back surgery is number one). There are more than 250,000 carpal tunnel surgeries performed every year in the United States, and growing. More than 8 million people are affected, and employers spend over $7.4 billion in workers comp costs yearly. Only 23% of all CTS surgery patients were able to return to their previous profession following surgery!

Here are some statistics on the CTS surgery. Initially after surgery, 80% of patients report about 75% relief of symptoms. The outcomes up to 36 months are a different story.  Only 27% are reported as good outcomes, 42% fair and 32% poor. There are 57% of the people who have recurrent symptoms at 2 years. At 5.5 years 57% still have pain, and 40% have permanent hand weakness!

A Canadian study showed that 4 years post operatively 46% still had moderate to severe pain, 52% had moderate to severe numbness and 40% had difficulty grasping small objects. Only 14% were symptom free!

So what is the carpal tunnel? It is literally a tunnel in the wrist formed on 3 sides by the bones of the wrist and covered by the flexor retinaculum ligament. Just picture a tunnel through a mountain, the concrete tunnel is made of bones and the road is the ligament connecting the two sides. Through that tunnel go many tendons of forearm muscles and the median nerve. Lying just above the ligament is the ulnar nerve.

The definition of carpal tunnel syndrome (CTS) is a painful condition with median nerve entrapment at the wrist most commonly from anything that causes a decrease in the size of the tunnel or anything that increases the contents of the tunnel. So the next time someone tries to tell you that CTS is caused by pregnancy, diabetes, obesity or whatever, this is technically not true. Those are contributing factors to CTS but not a cause. It has only 2 causes, but many contributing factors.

Most people (doctors included) think CTS is solely a repetitive stress condition, or chronic problem. It is not. Research says that even minor compression or angular forces may restrict local blood flow enough to prolong nerve conduction times. So if minor forces can cause this, what do you think gripping a steering wheel during an accident can do to your wrists?

This brings us to the most commonly used diagnostic test to confirm CTS, the nerve conduction test. As stated before, even minor trauma can affect nerve conduction. Studies of nerve conduction testing show they are only about 40% accurate, at best; and highly dependent on the skill of the practitioner. Inter-practitioner reliability is not very good, meaning one clinician finds one outcome and another clinician can’t confirm it or finds different results.

Injecting the wrist with cortisone shots does seem to reduce the pain temporarily, mainly due to the numbing agent found in the shot, not the inflammatory relief supposedly given by the cortisone.  The bad part of shots is that in the long run it increases the contents of the canal, and we said that is one of the causes of pain to begin with, right? 

The reason surgery has such a high failure rate is that the body repairs soft tissue injury with fibrotic scar tissue.  Once the ligament is cut, it does give immediate relief… which doesn’t last.  Wait 3 months to 5 years and all that scar tissue being made has just filled up the canal again, and you are right back to where you started, hence the 5 year symptom free rate of only 14%!

This information begs the question, “What do I do for my painful, numb hands if surgery is not likely to help?” My answer is that there are a “handful “of chiropractors specifically trained in manipulation of the bones of the elbow, wrist and hand with the Mally method. The whole problem starts with the bones that border the canal on three side crushing down on the canal causing a decrease in the size of the canal.  Repetitive injury or acute trauma can cause this to occur.  Manipulating these bones to decrease the compression is the way to decrease canal pressure. 

Laser therapy is also a big help in these conditions. These options are not a quick cure by any means, but surgical statics are so bad that conservative care must be attempted before any cutting is done. Ask your chiropractor if they are trained in the Mally method of extremity adjusting, and let them help you figure out some help for your condition.