Carpal Tunnel

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Carpal tunnel treatment Sydney

Our Chronic Pain treatment services

Treating Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is a form of neuropathic pain relates to the criteria of the International Association for the Study of Pain (IASP) which defines it as initiated or caused by a primary lesion or dysfunction of the median nerve.

Neuropathic pain is based on the symptoms (spontaneous or evoked pain, paraesthesia) and signs ( mechanical allodynia, thermal hyperalgesia) which may relate more closely to mechanisms and therefore be more helpful in identifying appropriate treatment. Patients with neuropathic pain typically describe pain of two types: (i) Constant burning pain (ii) intermittent shooting or electric pain. In addition, positive symptoms of paraesthesia, numbness and dysasthesia such as itching, crawling and tingling are highly suggestive of neuropathic pain. Results of neurological examination indicate negative signs of sensory, motor and reflex testing. The pain typically occurs adjacent to a region of sensory disturbance and may begin in weeks, months or years following initial insult to the nervous system.

Carpal tunnel syndrome (CTS) is a common peripheral neuropathy, our aim is to review the current literature on carpal tunnel syndrome, its signs and symptoms, diagnosis, differential diagnosis and treatment options, in this case the presentation to our clinic and the outcome of Chiropractic therapy.

In addressing the symptoms and history of the condition of CTS, as clinicians we need to address the age, sex and period of onset. Also needing to clarify the duration and intensity of the condition of which we use the Numerical Rating Scale (NRS). The patient is asked to describe and show where their symptoms are felt. Other setbacks/characteristics would be to assess the ability to hold objects, also would they develop numbness in the hand whilst holding objects.

Other symptoms as the condition interrupts their sleep pattern would they wake and need to “shake” their hand in an attempt to alleviate their symptoms, this would be disrupting their sleep pattern, leading to feeling fatigued during the day. As chronic pain is frequently associated with depression and sleep disturbance (4). Do these symptoms occur on a daily basis, does this affect their quality of life. Do they live at home alone, being in a capacity to look after themselves. Have they used splinting / immobilisation techniques, what are their outcomes, should all be documented?

Noting also of previous assessments/treatment consisting of chiropractic consultation with a hand surgeon, confirmation of the condition by way of nerve conduction and electromyography, showing any neurophysiological evidence of median neuropathy.

SURGERY HAS THE FOLLOWING RESULTS / OUTCOMES (5):

  • Surgical release of the carpal tunnel
  • Would need up to 6 weeks of incapacity with the use of the hand, with a 90-93% success rate.
  • Given the choice of a less invasive procedure of cortisone injection into the sheath of the wrist.
  • Given 7-10% outcome of not being cured, with possible detrimental injury to the median nerve and associated flexor tendons
  • There is a 1/100 chance of suffering an infection.
  • A 1/500 chance of abnormal reaction to surgery which may cause pain swelling and stiffness in the whole arm
    and last 6 months or more and sometimes leave permanent effects

Previous and current medical history is important as conditions such as diabetes can cause patients to succumb to peripheral neuropathies such as CTS as well as previous trauma such as fractures of the hand/wrist.

Chiropractic care can play a role in the management of peripheral neuropathies by supporting nerve health and circulation. Are they a social drinker or smokers, as this can be detrimental to tissue healing? Incorporating chiropractic care might mitigate some of these effects by fostering better overall health. Their main interests of recreation, sports, hobbies does the condition prevent them from pursuing these activities? Including chiropractic care could potentially enable them to resume these activities by improving spine health. General well-being and presentation, assessing whether they are anxious, or depressed, are they cooperative with history taking and want help with her condition. Chiropractic care and massage could offer benefits in improving general well-being and reducing symptoms of anxiety and depression. Assessing the status of their family relationships or if it is a compensation case / litigation all need to be considered as this can be a hindrance to positive outcomes. Introducing chiropractic care might support the healing process, thereby positively influencing these outcomes. Consideration of the type of employment can have some impact, for example, if their work is physical, this could affect treatment outcomes. Chiropractic care could be particularly beneficial in these cases by aiding in the recovery and maintenance of spine health.

In forming a pain formulation of the case (6) a barrier to recovery is accepting what procedures are available and their outcomes, having current underlying conditions such as cardiac, are elderly or pregnant can make them a non-candidate for any interventional procedures. Chiropractic care, being non-invasive, may offer a viable option for those unable to undergo surgery. Feelings of helplessness in terms of what to do with their condition, prolonging a positive outcome, further perpetuating the existing condition leading to fatigue and feelings of depression. Chiropractic interventions could provide new avenues for managing this condition, potentially alleviating feelings of helplessness.

It is important to explain to the patient the treatment offered at our clinic and what procedures are involved to make it effective so that the patient has a shared understanding of our procedures, that it being non-invasive/non-operative. Including an explanation of chiropractic care and its benefits could enhance patient understanding and acceptance of non-operative approaches to their condition. Giving a specified time-frame, for two reasons (i) it gives the patient an idea of how Chiropractic treatment works (ii) If the desired outcome is not achieved then treatment would cease, so expectations are met.

However the response would be slower and they would have to be patient and allow the programme of treatment to progress as prescribed, consisting of two sessions per week for four weeks which needed to be followed, this would gain their confidence and hence to participate as the aim is to improve the condition and subsequently their quality of life, this would be assessed by:
i) Pain levels, are they lessening, as the treatment is progressing, currently using NRS.
ii) Functional improvement, sleep without being woken up in numbness and pain. Chiropractic care could contribute significantly to functional improvement by addressing the root causes of numbness and pain.
iii) Holding objects pain free and confidently, for example holding the phone without developing numbness and being able to do their hobbies and recreational activities.
iv) Treatment is meeting the financial cost, cost-benefit efficacy as compared to surgery which involves the use of theatre, surgeon, anaesthetist, nursing staff which is a more expensive option. Opting for chiropractic care could be a more cost-effective approach, providing relief without the extensive costs associated with surgery.

In a majority of CTS patients the recommended management options are (8) conservative treatment which  include behaviour modifications, medications, including anti-inflammatory drugs and analgesics, immobilisation via splinting or bracing, physical and occupational therapy, oral corticosteroids and ultrasound.  There are indications that local injections with corticosteroids are less effective in the long term than surgical interventions. For long-term care, chiropractic interventions may provide a sustainable alternative to manage symptoms and improve quality of life. The surgical option, open or endoscopic carpal tunnel surgery entails greater risks of complications. Contrastingly, chiropractic care offers a non-invasive alternative that might reduce the risk of such complications.

IF YOU SUFFER FROM CARPAL TUNNEL SYNDROME, CONTACT DR GEORGE HARDAS AT SPINAL CARE IN SYDNEY, AND ARRANGE A CONSULTATION TO ASSIST WITH PAIN MANAGEMENT AND TREATMENT.