Carpal Tunnel Syndrome
Carpal tunnel syndrome is numbness, tingling, weakness, and other problems in your hand which is due to pressure on the median nerve in your wrist.
The median nerve and several tendons run from your forearm to your hand through a small space in your wrist called the carpal tunnel. Pressure on the median nerve causes carpal tunnel syndrome. This pressure can come from swelling or anything that makes the carpal tunnel smaller. Many things can cause this swelling, including:
- Illnesses such as rheumatoid arthritis and diabetes.
- Making the same hand movements over and over, especially if the wrist is bent down (your hands lower than your wrists), or making the same wrist movements over and over.
- Prevalence rates: 9.2% in women and 6% in men.
- Incidence rates: 1-3/1,000 people per year.
- CTS is most common in individuals aged 30 to 60 years old.
- It is more common in women than men because women tend to have smaller carpal tunnels.
A frozen shoulder is a shoulder joint with significant loss of its range of motion in all directions. The range of motion is limited not only when the patient attempts motion but also when the doctor attempts to move the joint fully while the patient relaxes. A frozen shoulder is medically referred to as adhesive capsulitis.
This extreme stiffness in the shoulder can occur at any age. Although the causes are not completely understood, although commonly occurs following minor trauma or if the shoulder has been kept immobile for a period of time. Most of the time there is no cause for frozen shoulder.
The hallmark sign of this condition is being unable to move your shoulder – either on your own or with the help of someone else. It develops in three stages:
In the”freezing” stage, you slowly have more and more pain. As the pain worsens, your shoulder loses range of motion. Freezing typically lasts from 6 weeks to 9 months.
Painful symptoms may actually improve during this stage, but the stiffness remains. During the 4 to 6 months of the “frozen” stage, daily activities may be very difficult.
Shoulder motion slowly improves during the “thawing” stage. Complete return to normal or close to normal strength and motion typically takes from 6 months to 2 years.
Symptoms of Carpal Tunnel and Frozen Shoulder
The following are the most common symptoms for carpal tunnel syndrome. However, each individual may experience symptoms differently. Symptoms may include:
- Difficulty gripping objects with the hand(s)
- Pain and/or numbness in the hand(s)
- “Pins and needles” feeling in the fingers
- Swollen feeling in the fingers
- Burning or tingling in the fingers, especially the thumb and the index and middle fingers
You may first notice symptoms at night. You may be able to get relief by shaking your hand. The reason symptoms are worse at night may be related to the flexed-wrist sleeping position and/or fluid accumulating around the wrist and hand while lying flat. Carpal tunnel syndrome may be a temporary condition that completely resolves or it can persist and progress.
As the disease progresses, patients can develop a burning sensation, and/or cramping and weakness of the hand. Decreased grip strength can lead to frequent dropping of objects from the hand. Occasionally, sharp shooting pains can be felt in the forearm. Chronic carpal tunnel syndrome can also lead to wasting (atrophy) of the hand muscles, particularly those near the base of the thumb and in the palm of the hand.
The main symptoms Frozen Shoulder is:
- Decreased motion of the shoulder
Frozen shoulder without any known cause starts with pain. This pain prevents you from moving your arm. Lack of movement leads to stiffness and then even less motion. Over time, you become unable to do movements such as reaching over your head or behind you.
Treatment of Carpal Tunnel and Frozen Shoulder
If diagnosed and treated early, carpal tunnel syndrome can likely be relieved without surgery. In cases where the diagnosis is uncertain or the condition is mild to moderate, your Chiropractor or Physio will always try simple treatment measures first.
Treatment varies depending on if the condition is acute or chronic. Also, the patient’s age, occupation, overall health, current functional level, and stage of the condition is taken into account when formulating the most appropriate treatment plan. Typically, conservative treatment consists of ergonomic education, splinting or bracing the wrist, and anti-inflammatory medications to decrease swelling.
- Chiropractic & Physical Therapy: Specific treatment and exercises can reduce inflammation and pressure on the median nerve as well as strengthen your arm and hand muscles. Advice on activity changes and patterns of hand use to avoid positions and activities that aggravate the symptoms may be helpful. If work requirements cause symptoms, changing or modifying jobs may slow or stop progression of the disease.
- Bracing or splinting. A brace or splint worn at night keeps the wrist in a neutral position. This prevents the nightly irritation to the median nerve that occurs when wrists are curled during sleep. Splints can also be worn during activities that aggravate symptoms.
- Medications. Simple medications can help relieve pain. These medications include anti-inflammatory drugs (NSAIDs), such as ibuprofen.
- Steroid injections. A corticosteroid injection will often provide relief, but symptoms may come back.
- Surgical Treatment. Surgery may be considered if you do not gain relief from nonsurgical treatments. The decision of whether to have surgery is based mostly on the severity of your symptoms.
Frozen shoulder generally gets better over time, although it may take up to 3 years.
The focus of treatment is to control pain and restore motion and strength through physical therapy.
More than 90% of patients improve with relatively simple treatments to control pain and restore motion. Some simple treatments may include the following:
- Non-steroidal anti-inflammatory medicines.
- Steroid injections. Cortisone is a powerful anti-inflammatory medicine that is injected directly into your shoulder joint.
- Chiropractic & Physical Therapy. Specific exercises will help restore motion. At Spinal and Sports Care, our practitioners will prescribe an exercise program to suit your lifestyle, whether it is at a gym with a personal trainer or via a home program. Therapy includes stretching or range of motion exercises for the shoulder, massage and mobilisation techniques as well as electro-physical therapies. Sometimes heat is used to help loosen the shoulder up before the stretching exercises.