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  • Dr. AJ Gagliardi

Carpal Tunnel Syndrome (Median Nerve Compression)

Carpal tunnel syndrome is a disorder affecting the median nerve as it courses through the wrist. “Estimates suggest that around 1 in 10 people develop carpal tunnel syndrome at some point” (2009 Drug and Therapeutics Bulletin). Most symptomatic carpal tunnel syndromes are caused by compression of the median nerve. This compression is what causes the pain, numbness, and weakness that most people experience with this pathology. Even though we call this disorder carpal tunnel syndrome, the problem may not be in the carpal tunnel itself. What most people do not know is that before the median nerve gets to the wrist it has to maneuver its way through four other structures in the arm. Due to this fact many so called “carpal tunnel syndromes” are misdiagnosed as so, leading to the improper management of the patient and a recurrence of symptoms. Because this title “carpal tunnel syndrome” is so misleading I refer to this disorder as Median Nerve Compression, until it can be proven the problem is within the carpal tunnel itself.

So if you have this bad boy what will you be feeling you ask? Symptoms differ patient by patient, but most people will experience pain or numbness over the thumb, index finger, and middle finger. Some patients also have reported weakness with activities such as opening a jar or turning a door knob. What I have found to be reported most often is the patient stating, “I wake up in the middle of night with hand tingling, and I have to flick and/or shake my hands to relieve the numbness or tingling.” This is what we call the “Flick Test.” If this is occurring you may have the beginning of a median nerve compression syndrome.

There are many different treatment options for this dysfunction. Surgery is one option while taking a conservative approach is another. Surgery is aimed at cutting the ligament which covers the carpal tunnel to increase the room that the median nerve has within the wrist. Manual medical providers such as Chiropractors are people who can, and will provide conservative management for this nerve compression syndrome. We do this by using a multi-faceted approach. This can include nerve gliding mobilization, muscular manipulation like Active Release Technique, and anti-inflammatory nutritional counseling to non-invasively remove tension and increase space to completely remove the patient’s symptoms. Because the median nerve can be compressed not only within the carpal tunnel, but also within 4 other muscular and ligamentous compartments within the entire arm it is important to know that these other areas are problem free before you have surgery. Surgery is a must for some people, but with a 3-19% post-surgical fail rate and recurrence of symptoms, scientific evidence is showing that patients with this dysfunction should first enter a trial of conservative care.

Tips to avoid Median Nerve Compression:

  1. Take frequent short breaks instead of few long ones

  2. Keep your hands and wrists straight while typing (no bend)

  3. Frequently stretch your wrists and hands throughout your entire day

  4. Eating essential fatty acids (i.e.-fish oils), turmeric, and ginger will help decrease inflammation decreasing your risk for such problems

  5. Avoid smoking