Anatomy in Action Series: Carpal Tunnel Syndrome
Educational articles designed to help CAs understand the underlying anatomy and physiology of conditions presenting to the chiropractic office.
Laurie Mueller
Compressive Syndromes
There are several "tunnels" or "compartments" in the body where structures such as nerves or blood vessels travel to reach outlying body parts. When the structures comprising the tunnel misalign or spasm, compression of the contents (blood vessels and nerves) can lead to uncomfortable symptoms, such as numbness, tingling, pain, or weakness.
The carpal tunnel is one such compartment in the body located at the wrist, and carpal tunnel syndrome is a condition that occurs when the structures that make up the compartment create compression to the nearby median nerve bundle.
The Borders of the Carpal Tunnel
The tunnel itself is created by four of the eight bones of the wrist (carpals) at the posterior and the flexor retinaculum, which is a ligamentous structure that spans the anterior portion of the wrist and provides stability.
Each of the eight carpals has a name; we have shown the names of the four involved in the diagram.
The Contents of the Tunnel
Within the tunnel compartment, we can find nine
flexor tendons. These span from the muscle bellies in the forearm to the bones of the hand and serve to provide flexion in the fingers and hand when the flexor muscles contract.
Traveling through the tunnel, we also find the median nerve. The median nerve has contributions from the C5, C6, C7, C8, and T1 spinal levels as the ventral nerve roots become part of the brachial plexus nerve network, which supplies the upper extremity. Compression of the
nerve may cause numbness, tingling, pain, and muscle weakness in the hand depending on the extent of the compression.
What Causes the Symptoms?
Nerve compression in the tunnel can be caused by a variety of structures. If one or more of the carpal bones is misaligned, certainly the space insidethetunnel can be diminished. Ifthe flexor tendons are inflamed and enlarged, that can also diminish the space.
Often these things will occur together. Subluxation of the carpal bones can occur through overuse, a bump or fall, or from an injury, such as a sprain/strain. Inflamed tendons can manifest from any type of work that "overuses" the muscles. Factory work on an assembly line, construction, cashier work, and secretarial work could all be potential culprits. Such overuse would also fall into the strain category.
Management of Carpal Tunnel
When the DC creates a care plan for a patient with carpal tunnel syndrome, he orshe will address the issues of misaligned bones through chiropractic adjustments. The DC will also work to alleviate the inflammation in
“An understanding for anatomy helps all health office employees better communicate with patients and provide care more safely. ”
the tendons and the associated muscle spasm in the flexor muscle bellies in the arm. Doctors who work with nutrition may also recommend a calcium/magnesium supplement, and some may even recommend an herbal supplement such as St. John's Wort, which helps promote muscle relaxation.
Rest of the area is paramount to healing and also may include the patient wearing a brace on his or her wrist to keep it in a neutral position.
From the perspective of physiotherapy, the DC may recommend ice over the wrist to help reduce inflammation. The DC may also consider ultrasound or electric muscle stimulation on the muscle bellies to promote relaxation. Certainly, the ergonomic working conditions of the patient also should be addressed to try to alleviate the source of the overuse. Sometimes this is as easy as altering a workstation or computer desk, but it also may include alternating the position of the patient at work so that the he orshe is not always doing the same activity. For example, a patient could switch from the right to the left side of an assembly line to allow for rest of one set of muscles and to balance out the stressors.
When the doctor analyzes the initial hand symptoms, he or she must also rule out disc or facet syndrome in the associated spinal levels, thoracic outlet syndrome affecting blood supply, and fixation at the elbow joint.
Chiropractic can be a very effective noninvasive treatment for carpal tunnel syndrome. Surgery is also an option for severe cases. During the surgical procedure, the surgeon will cut or lengthen the flexor retinaculum tendon. This can be effective for some patients, but for many, it is only a short-term fix because scar tissue will develop near the incision and once again create a compression. Patients should fully understand the involved risks whenever undergoing surgery.
Education Fosters Understanding
An understanding of anatomy helps all health office employees better communicate with patients and provide care more safely. Online training programs make highquality training affordable and convenient, and can be taken any time of day. At www.CCCAonline.com, learners can engage in a streamlined 24-hour training program that meets or exceeds FCLB guidelines in every area of study, as well as fulfill the training requirement needed for the national examination!
DCs often will payfortheir employees to train. Full price for this training is an affordable $339 for the entire 24-hour program. CCCAonline.com offers a discount for readers of The American Chiropractor magazine\ Use AM CHIRO as your discount code. When you enter this code during the registration process, it will automatically provide a $15 discount off the regular price of the full program. This is the program that gives back to the profession.
Learners can expect text, images/schematics, dynamic video lectures, and robust customized, experiential interactivities in a thorough 19-module program. Plus, an extensive note-packet of nearly 200 pages is included and can be downloaded, printed, and studied off-line. Learners work at their own pace and can conveniently take programming around work hours to avoid disruption in the office. Questions? Visit our website or send us an email at [email protected].
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B Laurie Mueller, BA, DC, served in private practice
in San Diego, California. She was the postgraduate director at Palmer College from 2000 to 2010; served as the ACC postgraduate subcommittee chair for six years; peer reviewedfor the Research Agenda Conference; and wrote the informal role determination study that aided in the development of FCLB ’s guidelines for chiropractic assistants. Dr. Mueller currently works as a private eLearning consultant with a focus on healthcare topics and functional medicine through her company, Impact Writing Solutions, and subsidiary, www.CCCAonline.com. She is a clinician, an educator, and an expert in online educational pedagogy.
