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What is Carpal Tunnel Syndrome ?
Carpal tunnel syndrome (CTS) is a condition, which results when the median nerve does not work properly. Usually, this is thought to occur because there is too much pressure on the nerve as it runs into the wrist through an opening called the carpal tunnel. It may be easier to understand how this occurs if you understand some of the anatomy of the wrist.
Dr Shoshany and his team of specialists treat Carpal Tunnel Syndrome in New York City using an array of techniques. The specific technique, or course of treatment is determined by a number of factors. After taking a detailed history of the patient, and their injury, an individualized program is created focused on providing long term relief using proven solutions and protocols. The exact tools and procedures used are determined by the patient's age, activity level, goals, lifestyle, and the cause of their pain.
The end goal is to get the patient out of pain quickly using various methods like:
- cold laser therapy,
- Class 4 Deep Laser Therapy
- Graston Technique
- Kinesio Taping
- Massage Therapy
- Active Release Technique
- Physical Therapy and Corrective Exercise
Depending on how quickly the injury responds to treatment, the patient is then ready to start physical therapy. Our in-house physical therapy department in NYC works with the chiropractors to ensure that the underlying skeletal tissue and musculature are as strong and flexible as possible, so the likelihood of the recurrence of carpal tunnel syndrome can be avoided as much as possible.
The Physiology of Carpal Tunnel Syndrome
The median nerve runs into the hand to supply sensation to the thumb, index finger, long finger, and half of the ring finger. The nerve also supplies a branch to the muscles of the thumb, the thinner muscles. These muscles help move the thumb and are very important in moving the thumb so that you can touch each of the other fingers. This motion is called op-position.
The carpal tunnel is an opening into the hand that is made up of the bones of the wrist on the bottom and the transverse carpal ligament on the top. Looking at a cross section of the wrist allows one to visualize the anatomy of the carpal tunnel. Through this opening called the carpal tunnel, the median nerve and the flexor tendons run into the hand. Looking a little closer, we see that the median nerve lies just under the transverse carpal ligament.
The flexor tendons are important because they allow us to move the fingers and the hand, such as when we grasp objects. The tendons are covered by a material called tenosynovium. The tenosynovium is very slippery, and allows the tendons to glide against each other as the hand is used to grasp objects. Any condition which causes irritation or inflammation of the tendons can result in swelling and thickening of the tenosynovium. As the tenosynovium covering all of the tendons begin to swell and thicken, the pressure begins to increase in the carpal tunnel because the bones and ligaments that make up the tunnel are not able to stretch in response to the swelling. Increased pressure in the carpal tunnel begins to squeeze the median nerve against the transverse carpal ligament - because the nerve is the softest structure in the carpal tunnel. Eventually, the pressure reaches a point when the nerve can no longer function normally. Pain and numbness in the hand begins.
One of the first symptoms of carpal tunnel syndrome is numbness in the distribution of the median nerve. This is quickly followed by pain in the same distribution. The pain may also radiate up the arm to the shoulder, and, some-times the neck. If the condition is allowed to progress, weakness of the thenar muscles can occur. This results in an inability to bring the thumb into opposition with the other fingers and hinders one's grasp.
There are many conditions, which can result in irritation and inflammation of the tenosynovium, and eventually cause carpal tunnel syndrome. Different types of arthritis can cause inflammation of the tenosynovium directly. A fracture of the wrist bones may later cause carpal tunnel syndrome if the healed fragments result in abnormal irritation on the flexor tendons. The Key Concept to remember is that anything, which causes abnormal pressure on the median nerve will result in the symptoms of pain, numbness and weakness of carpal tunnel syndrome. Recently, physicians have begun to recognize that activities that involve highly repetitive use of the hands can result in carpal tunnel syndrome. This is thought to be caused by inflammation and swelling of the tenosynovium due to overuse.
Diagnosing Carpal Tunnel Syndrome
Evaluation in our NYC Chiropractic office begins with your doctor obtaining a history of the problem, followed by a thorough physical examination. Your description of the symptoms and the physical examination are the most important parts in the diagnosis of carpal tunnel syndrome. Commonly, patients will complain first of waking in the middle of the night with pain and a feeling that the whole hand is asleep. Careful investigation usually shows that the little finger is unaffected. This can be a key piece of information to make the diagnosis. If you awaken with your hand asleep, pinch your little finger to see if it is numb also, and be sure to tell your doctor if it is or is not. Other complaints include numbness while using the hand for gripping activities, such as sweeping, hammering, or driving. The major physical findings reflect that pressure is increased in the carpal tunnel. If more information is needed to make the diagnosis, electrical studies of the nerves in the wrist may be requested by your doctor. Several tests are available to see how well the median nerve is functioning, including the nerve conduction velocity (NCV). This test measures how fast nerve impulses are conducted through the nerve. This test is available in our NYC medical and Chiropractic practice and is covered by most medical carriers.
Carpal tunnel syndrome is a painful condition that occurs as a result of an impinged nerve in the wrist area. The carpal tunnel is a narrow cavity in the wrist, which is meant to safeguard the median nerve, the main nerve that regulates hand function as well as the tendons that control hand and finger movement. When the carpal tunnel is compressed or swollen, it will place extra pressure on the nerve, resulting in hand numbness, tingling, weakness, loss of hand coordination, and pain that can extend along the arm – symptoms known as carpal tunnel syndrome. Advanced cases of carpal tunnel syndrome may present permanent tissue deterioration of the affected muscles and tendons.
Common causes of carpal tunnel syndrome include extended computer use, driving, manual labor, as well as unnatural patterns of hand use that may cause injury, such as improper heavy lifting and/or exercising. Patients of all age groups are susceptible to developing conditions that could result in entrapment of the median nerve, causing carpal tunnel syndrome, but the rate of incidence is higher in patients between 30 and 60 years of age
Treatment for Carpal Tunnel Syndrome in New York City
Fortunately, the damage caused by carpal tunnel syndrome is treatable and in most cases reversible. Dr. Steven Shoshany utilizes the latest technology and a holistic non-surgical approach to effectively and painlessly treat patients in NYC who present signs of carpal tunnel syndrome. With some of the best diagnostic tools at his disposal, including the Sonosite M-Turbo musculoskeletal ultrasound device, Dr. Shoshany is able to accurately diagnose and design a customized treatment protocol for each patient by first analyzing the cause and extent of damage.
Through a personalized combination of specialized treatments, Dr. Steven Shoshany has helped hundreds of New Yorkers' find permanent pain relief by reversing the damage caused by carpal tunnel syndrome and addressing its root cause. Treatments made available by Dr. Shoshany and his team to patients in NYC who experience carpal tunnel syndrome include manual decompression, Active Release Technique® (ART), Graston Technique®, physical therapy, cold laser therapy, kinesio taping, acupuncture, pain management, and more. All treatments offered at Dr. Shoshany’s state-of-the-art rehabilitation center in NYC are non-surgical and offer prompt results and long-term improvement.