How To Deal With Carpal Tunnel Syndrome

Any time someone has pain, numbness and tingling in the hand(s), we have to think about the possibility of carpal tunnel syndrome.  The carpal tunnel is significant because the median nerve, which supplies muscles to your hand and fingers, runs under this tunnel.  It is formed by the boundaries of the flexor retinaculum (carpal ligament), which serves as the roof, and the carpal bones of the hand, which serves as the floor. Along with the median nerve, there are nine other tendons in this tunnel, whose respective muscles flex the wrist and fingers.

This condition is most commonly found in sports/activities/occupations that involve forceful and/or repetitive hand movements (eg. keyboarders, assembly-line workers, carpenters, butchers, work where hand-held devices are subject to vibration, cycling, racquet sports, knitting). It can also occur in women who are pregnant.

Common Signs and Symptoms:

Burning, tingling, pins and needles, and/or numbness in the thumb and first 2 fingers that may radiate up the arm
Weakness in the hand when gripping
Pain that is worse at night
Pain with sustained wrist flexion or repetitive wrist movements

Why does it happen?

Compression of the median nerve in the carpal tunnel can occur due to several reasons. Firstly, it can be caused by repetitive strain/overuse of the wrist muscles causing thickness and scarring of the tendon sheaths or inflammation and swelling of the tendons themselves. Secondly, it can be caused by direct trauma to the wrist, resulting in swelling. Lastly, it can be caused by systemic factors, such as pregnancy, rheumatoid arthritis, or diabetes. In all three cases, the symptoms arise due to compression on the median nerve. If this syndrome is caught early and treated appropriately, a full recovery is likely. However, should symptoms last longer than 12 months and/or the syndrome isn’t being treated effectively, surgery to release the carpal ligament may be indicated.

If you are trying to avoid surgery, physiotherapy can help to reduce your pain and inflammation, increase your wrist/finger movement and strength, and help educate on what positions you should avoid. If you have had surgery, we can help with your post-operative pain and swelling, decrease your physical scar and the scar tissue that will form, help desensitize the nerve, and assist you in regaining your functional strength.

Therapeutic modalities that we use in the clinic during treatment to help with pain and inflammation/swelling may include ultrasound, laser, electrical current, ice, and taping.  In some case, wearing a night splint may also be suggested. We will also provide you with a specific exercise program including stretching and strengthening for you to do at home. It’s important for us to work together to maximize your function and get you back to doing the things you love.

Leanna Taggio, Physiotherapist


Laser Therapy Vs. Other Therapies

Ever since I started using laser therapy in my practice 8 years ago, my old ultrasound and electric stim machine has been progressively sitting more and more by the wayside.  In fact, for the last 4 years, I haven’t even turned the old device on….it just sits by the wall of one of my treatment rooms collecting dust and every now and then a patient will say: “What’s that machine for?”

Comparatively speaking, I haven’t found ultrasound or electric stim anywhere near as effective as laser therapy for pain and muscle, joint or nerve injuries.  That’s not to say laser therapy is 100% full proof because nothing is.  But I will say that I consistently get great results with laser on a wide variety of patient conditions.

Below is a great summary chart that compares the use of laser and other common therapies used in chiropractic, physiotherapy and massage clinics.

Laser therapy can be used to treat so many different effects, can treat so many different things and has so few precautions which makes it an ideal therapeutic tool.

If you are in Richmond Hill, Aurora, King City or Newmarket and haven’t tried laser therapy for your pain or injury, maybe it’s time to give us a call and see how we can help!

Dr. Keith

Chiropractic ‘Self-Defense’ Tips for Your Elbows & Wrists

When we look at issues affecting the elbows, wrists and hands, we’re mostly talking about overuse injuries.  When you use a computer mouse, screwdriver or tennis racquet for hours on end, you forget to use the leverage of the whole upper body.  As a result, you find that the muscles of the neck and shoulder get fatigued and tense from lack of movement while the smaller muscles in the forearm tire out from performing repeated small movements without a break.  In the last two weeks, I’ve had a male computer programmer and avid female tennis player come to me for treatment for repetitive stress injuries to the elbow and forearms.

You’d never think that clicking on a computer mouse or typing on a keyboard would be so ‘hazardous’ to your health.  In fact, you usually don’t realize it until the muscles in your forearms have been pushed over the edge into irritation and inflammation.  At this point, even turning a doorknob, holding a coffee cup or pulling laundry out of the washing machine causes you to wince in pain.

Within the confined space and area of the forearm, there are about 20 different muscles to control flexion, extension and rotation (pronation/supination) of the wrist.  Plus a whole bunch of nerves and blood vessels.  That’s a recipe for something getting compressed and triggering pain and dysfunction.  If you want to take a proactive approach to avoiding common problems like tennis/golfer’s elbow (tendonitis/tendinosis), carpal tunnel syndrome and DeQuervain’s syndrome, follow these self-defense tips:

  1. Adjust your computer desk to accommodate you better.  When you are typing, you should be able to keep your wrists straight and your elbows bent at 90 degrees.  Most desks are set too high so you can either place your keyboard on your lap or get a sliding keyboard tray.
  2. When you’re typing or doing housework or repairs around the house that involve alot of wrist movement or gripping, take breaks as often as possible.  Every 30 minutes should be the bare minimum.
  3. With any type of work, whether you are carrying groceries or using a screwdriver, keep your arms in as close to your body as possible.  The further out that you extend your arms, the more stress you end up putting on the elbow and wrist while exerting strength to perform the activity.
  4. If you have any current hand/wrist nerve problems, wearing a splint when sleeping is a good idea.  This is because most people sleep with their wrists curled up which causes more compression on nerves and blood vessels in the wrist.
  5. If you are a regular tennis player or golfer, you should get frequent technique tuneups from a teaching pro.  Minor adjustments to your swing or stroke can help prevent injuries.  Or possibly the racquet or clubs you are using are wrong for you.  A pro will be able to assess that for you too.
  6. If you lift weights regularly, make sure you balance out any arm flexor exercises (eg.  bicep curls, wrist curls) with extensor exercises (eg. tricep extensions, wrist extensions).  Injuries very commonly occur because there is an imbalance between opposing muscle groups.

Injuries can be avoided or minimized and now you have some more tips to get you started.  But it all boils down to you actually doing them!  Otherwise I may be seeing you in my Richmond Hill office for treatment on your elbow or wrist some time soon!

Prevention is the best medicine!

Dr. Keith