What Are Compression Syndromes?
Laurie Mueller
BA, DC, CFMP
What Are Compression Syndromes?
In the office, you may have coded for or heard your DC talk about compression syndromes. In a nutshell, when you hear the word "compression," it means that there is entrapment or pressure being put on one or more nerves. Compression syndromes include things such as:
• Carpal tunnel syndrome
• Thoracic outlet syndrome
• Compartment syndrome versus shin splints (medial tibial stress syndrome)
This article was designed to help you understand more about compression. Signs and symptoms can include things such as tingling, numbness, or even a burning sensation in the body that corresponds to the nerve affected.
A nerve can be compressed by prolonged or repeated external force. This could be from things such as repetitive factory work, sitting in an ergonomically compromised position that leads to inflammation in a compartment, or physical issues, such as a hematoma or cyst compressing an area.
Carpal Tunnel Syndrome
The carpal tunnel or carpal canal is the passageway on the palmar side of the wristthat connects the forearm to the hand. On one side, it is bordered by wrist bones and on the other by the flexor retinaculum tendon. Within the space, we find the flexor muscle tendons and the median nerve.
Movements of the wrist can affect the shape and width of the tunnel. Repetitive movements can also cause inflammation in the tendons, which can compress the nerve. In the chiropractic office, we work to reduce inflammation and restore proper alignment of the wrist bones, which could cause pain or impinge the tunnel. In extreme cases, surgeons will go in and actually cut through the flexor retinaculum tendon to relieve pressure.
Thoracic Outlet Syndrome (TOS)
TOS can affect the compression of nerve, arteries, or veins in the passageway from the lower neck to the armpit. Thoracic outlet boundaries include the clavicles, first ribs, scalene muscles, subclavius musculature, and pectoralis minor. The brachial plexus (nerves), subclavian artery, and subclavian vein can be affected with spasm, inflammation, injury, or misalignment of these structures.
If a patient anatomically is born with an extra rib about their first rib, this could also reduce the size of the thoracic outlet. Poor posture and obesity are other risk factors. Of course, injury or overuse are also common causes of impingement.
Symptoms of TOS include pain, numbness, or weakness in parts of the neck, shoulder, or hand, which indicates nerve involvement. Compressed blood vessels may cause symptoms including swelling, redness, hands, or arms that feel cold to touch or hands/arms that become easily fatigued.
Chiropractic and lifestyle changes can successfully treat a great number of TOS cases. In some instances, like having an extra rib, surgery may be warranted to remove that rib if symptoms cannot be improved with other methods. Practicing proper posture, taking breaks, maintaining a healthy weight, exercise, and avoiding offending movements are all important preventative measures.
Shin Splints versus Compartment Syndrome
Shin splints are also called "medial tibial stress syndrome." It is an exercise-related problem that creates pain (could be razor-sharp or dull and throbbing and occur in one or both legs) along the inner edge of the shinbone (tibia) and may cause some swelling. It typically develops after physical activity, especially with running, but any vigorous sports activity can bring on the symptoms.
Having flat feet or wearing worn-out footwear can predispose patients to the problem. Shin splints are defined as inflammation of the muscles, tendons, and bone tissues around the tibia, and pain will mainly occur where muscles attach to bone.
It is very important to rule out "compartment syndrome," which is more serious but can have similar symptoms and build pressure in muscular tissues to dangerous levels. This condition can be accompanied by pain, paresthesias, and tenderness in the region supplied by the common fibular nerve. Compartment syndrome is a medical emergency, and the pressure in the leg must be relieved to restore blood flow or cell death and amputation could occur.
"In a nutshell, “compression,” means that there is entrapment or pressure being put on one or more nerves."
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Laurie Mueller, BA, DC, CFMP served in private practice in San Diego, California. She M’as the post-graduate director at Palmer College from 2000-2010; served as the ACC Post Graduate subcommittee chair for 6 years; and peer reviewed for the Research Agenda Conference.
