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Causes, Symptoms, & Treatments
Presented by:
Dr. Clay Kuethe
Carpal Tunnel (An Overview)
 Where is the Carpal Tunnel?
 The Carpal Tunnel is in your
wrist.
 It is made up of the carpal
bones and the flexor
retinaculum (transverse
carpal ligament).
 Pneumonic for carpal bones
 Some Lover’s Try Positions
That They Can’t HandleCarpal Bones
Carpal Bones
 Scaphoid
 Lunate
 Triquetrum
 Pisiform
 Trapezium
 Trapezoid
 Capitate
 Hamate
What Is In The Carpal Tunnel?
 The median nerve which
is the nerve supply for
the palm side of your
hand.
 The flexor tendons of the
muscles that flex your
wrist, hand, and fingers.
 Sometimes, arteries and
veins that supply the
hand.
Some Symptoms of Carpal Tunnel
Syndrome
 Numbness, tingling, and/or pain in the
thumb, pointer finger, middle finger, and half of
the ring finger.
 Usually no pain in the palm, sensory nerve given
off before entering the carpal tunnel
 Weakness or clumsiness in gripping
 Atrophy of the thenar eminence
 Pain in the wrist, forearm, elbow, or shoulder.
 Fingers turning purple
 Symptoms can be relieved temporarily by shaking
the hands, putting in hot water, or resting them.
Some Tests to Check for Carpal
Tunnel Syndrome
 Tinel’s sign: Involves
tapping over the carpal
tunnel to elicit
numbness or tingling in
the fingers(between
60%-80% effective)
 Phalen’s test: Pressing
the backs of the hands
together to elicit
symptoms (between
49%-64% effective)
 Reverse Phalen’s:
Pressing the palms of the
hands together (between
49%-64% effective)
 Pressure Provocative
Test: Putting direct
pressure over the carpal
tunnel to elicit
symptoms (100%
effective)
Causes of Carpal Tunnel Syndrome
 Women are actually 3
times more likely to have
symptoms of carpal tunnel
syndrome.
 Most often a result of a
person’s occupation.
 Activities requiring
continual use of the hands
 Repetitive motions using
force
 Prolonged flexion or
extension of the wrist
 Gripping
 Pressure over the palm
 Trauma
 Fractures
 Vibration
 Examples: data-entry, meat
cutters, assembly, construc
tion workers, and
musicians
How Do These Activities Cause
Carpal Tunnel Syndrome?
 Excess or strained
movement, such as
typing, mouse
use, assembly line
movements.
 Micro-bruises can form
along these tendons if
overused and as they
heal, scar tissue can form.
 Scar tissue forms in an
attempt to help stabilize an
area.
How Do These Activities Cause
Carpal Tunnel Syndrome? (cont)
 Scar tissue will connect
structures together, such
as tendons, in order to
give them stability
 The median nerve can
also become entrapped
when scar tissue forms
 This restricts the normal
movement of the nerve
in the carpal tunnel
 This results in more
pulling and tugging on
the nerve, which causes
inflammation.
 Inflammation irritates
the nerve and can also
draw fluid to the
area, causing swelling.
 Scar tissue formation can
also cause the nerve to
be compressed
What Else Could It Be?
 C6 or C7 nerve root
lesion (Subluxation)
 Disc disease of the
cervical spine
 Pronator Teres
Syndrome
 Cubital Tunnel
Syndrome
 Tunnel of Guyon
Syndrome
 Radial Tunnel Syndrome
 Posterior Interosseous
Nerve Syndrome
 Carpal Subluxation
C6 or C7 Nerve Root Lesion(Subluxation) &
Cervical Discogenic Disease
 Subluxation of either the
C6 or C7 vertebra can
cause inflammation at
the nerve root, which
can cause neuropathy in
the median nerve
 Will often have radiating
pain down the
arm, which may be
relieved by distraction of
the cervical vertebrae C6/C7
foramen
C6
C7
Pronator Teres Syndrome
 The median nerve is
compressed before it
reaches the carpal tunnel
in between the two
heads of the pronator
teres.
 Pain when pronating
flexed wrist against
resistance.
 Sensations in the palm
may be reduced.
Cubital Tunnel Syndrome
 The ulnar nerve becomes
trapped on the medial
side of the elbow.
 This can cause pain and
sensory deficits in the
ulnar nerve distribution
of the hand.
 The medial half of the
palm and 5th and the
medial half of the 4th
digit.
Tunnel of Guyon Syndrome
 Tunnel where ulnar
nerve and artery cross
the wrist into the hand.
 Hypothenar wasting and
sensory deficits in the
highlighted area.
 May also be the artery
becoming compressed
and causing sensory
losses.
Radial Tunnel Syndrome
 Entrapment of the radial
nerve in the lateral
aspect of the elbow.
 Pain with elbow flexion
of elbow and pronation
of wrist.
 Radial nerve supplies the
posterior aspect of the
hand and extensor
musculature of the
forearm.
Posterior Interosseous Nerve
Syndrome
 Entrapment of the motor
branch of the radial
nerve.
 Wrist extension will be
weak.
 Pain with forceful wrist
extension.
How Do You Treat It?
 Chiropractic
adjustments if the main
cause is cervical
degenerative disease or
subluxation.
 Chiropractic
adjustments of the
shoulder, elbow, or wrist
if there is a subluxation
of these areas.
 Myofascial release if the
cause is muscular or
connective tissue in
nature.
 Anti-inflammatory
medication to reduce
swelling and
inflammation.
 Surgery as a last option
to relieve pressure in the
carpal tunnel.
Have Questions? Just Call or Send
an E-mail
 516 W. 35th St.
 Davenport, IA 52806
 Phone: 563-388-6364
 E-mail: drclay@familycarechiropracticdavenport.com
 familycarechiropracticdavenport.com
 facebook.com/FamilyCareChiropractic1
 Twitter: @Davenportchiro

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Carpal Tunnel Syndrome

  • 1. Causes, Symptoms, & Treatments Presented by: Dr. Clay Kuethe
  • 2. Carpal Tunnel (An Overview)  Where is the Carpal Tunnel?  The Carpal Tunnel is in your wrist.  It is made up of the carpal bones and the flexor retinaculum (transverse carpal ligament).  Pneumonic for carpal bones  Some Lover’s Try Positions That They Can’t HandleCarpal Bones
  • 3. Carpal Bones  Scaphoid  Lunate  Triquetrum  Pisiform  Trapezium  Trapezoid  Capitate  Hamate
  • 4. What Is In The Carpal Tunnel?  The median nerve which is the nerve supply for the palm side of your hand.  The flexor tendons of the muscles that flex your wrist, hand, and fingers.  Sometimes, arteries and veins that supply the hand.
  • 5. Some Symptoms of Carpal Tunnel Syndrome  Numbness, tingling, and/or pain in the thumb, pointer finger, middle finger, and half of the ring finger.  Usually no pain in the palm, sensory nerve given off before entering the carpal tunnel  Weakness or clumsiness in gripping  Atrophy of the thenar eminence  Pain in the wrist, forearm, elbow, or shoulder.  Fingers turning purple  Symptoms can be relieved temporarily by shaking the hands, putting in hot water, or resting them.
  • 6. Some Tests to Check for Carpal Tunnel Syndrome  Tinel’s sign: Involves tapping over the carpal tunnel to elicit numbness or tingling in the fingers(between 60%-80% effective)  Phalen’s test: Pressing the backs of the hands together to elicit symptoms (between 49%-64% effective)  Reverse Phalen’s: Pressing the palms of the hands together (between 49%-64% effective)  Pressure Provocative Test: Putting direct pressure over the carpal tunnel to elicit symptoms (100% effective)
  • 7. Causes of Carpal Tunnel Syndrome  Women are actually 3 times more likely to have symptoms of carpal tunnel syndrome.  Most often a result of a person’s occupation.  Activities requiring continual use of the hands  Repetitive motions using force  Prolonged flexion or extension of the wrist  Gripping  Pressure over the palm  Trauma  Fractures  Vibration  Examples: data-entry, meat cutters, assembly, construc tion workers, and musicians
  • 8. How Do These Activities Cause Carpal Tunnel Syndrome?  Excess or strained movement, such as typing, mouse use, assembly line movements.  Micro-bruises can form along these tendons if overused and as they heal, scar tissue can form.  Scar tissue forms in an attempt to help stabilize an area.
  • 9. How Do These Activities Cause Carpal Tunnel Syndrome? (cont)  Scar tissue will connect structures together, such as tendons, in order to give them stability  The median nerve can also become entrapped when scar tissue forms  This restricts the normal movement of the nerve in the carpal tunnel  This results in more pulling and tugging on the nerve, which causes inflammation.  Inflammation irritates the nerve and can also draw fluid to the area, causing swelling.  Scar tissue formation can also cause the nerve to be compressed
  • 10. What Else Could It Be?  C6 or C7 nerve root lesion (Subluxation)  Disc disease of the cervical spine  Pronator Teres Syndrome  Cubital Tunnel Syndrome  Tunnel of Guyon Syndrome  Radial Tunnel Syndrome  Posterior Interosseous Nerve Syndrome  Carpal Subluxation
  • 11. C6 or C7 Nerve Root Lesion(Subluxation) & Cervical Discogenic Disease  Subluxation of either the C6 or C7 vertebra can cause inflammation at the nerve root, which can cause neuropathy in the median nerve  Will often have radiating pain down the arm, which may be relieved by distraction of the cervical vertebrae C6/C7 foramen C6 C7
  • 12. Pronator Teres Syndrome  The median nerve is compressed before it reaches the carpal tunnel in between the two heads of the pronator teres.  Pain when pronating flexed wrist against resistance.  Sensations in the palm may be reduced.
  • 13. Cubital Tunnel Syndrome  The ulnar nerve becomes trapped on the medial side of the elbow.  This can cause pain and sensory deficits in the ulnar nerve distribution of the hand.  The medial half of the palm and 5th and the medial half of the 4th digit.
  • 14. Tunnel of Guyon Syndrome  Tunnel where ulnar nerve and artery cross the wrist into the hand.  Hypothenar wasting and sensory deficits in the highlighted area.  May also be the artery becoming compressed and causing sensory losses.
  • 15. Radial Tunnel Syndrome  Entrapment of the radial nerve in the lateral aspect of the elbow.  Pain with elbow flexion of elbow and pronation of wrist.  Radial nerve supplies the posterior aspect of the hand and extensor musculature of the forearm.
  • 16. Posterior Interosseous Nerve Syndrome  Entrapment of the motor branch of the radial nerve.  Wrist extension will be weak.  Pain with forceful wrist extension.
  • 17. How Do You Treat It?  Chiropractic adjustments if the main cause is cervical degenerative disease or subluxation.  Chiropractic adjustments of the shoulder, elbow, or wrist if there is a subluxation of these areas.  Myofascial release if the cause is muscular or connective tissue in nature.  Anti-inflammatory medication to reduce swelling and inflammation.  Surgery as a last option to relieve pressure in the carpal tunnel.
  • 18. Have Questions? Just Call or Send an E-mail  516 W. 35th St.  Davenport, IA 52806  Phone: 563-388-6364  E-mail: drclay@familycarechiropracticdavenport.com  familycarechiropracticdavenport.com  facebook.com/FamilyCareChiropractic1  Twitter: @Davenportchiro