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Carpal Tunnel Syndrome as a Cumulative Trauma Disorder

Carpal Tunnel Syndrome as a Cumulative Trauma Disorder
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Carpal tunnel syndrome (CTS) occurs when the mobility of the median nerve is constricted as it passes through the wrist, leading to symptoms in parts of the hand and fingers such as numbness, tingling, pain, and weakness. While it’s possible for CTS to arise following an acute injury—like a wrist fracture—or from hormonal changes that cause swelling in the wrist—like pregnancy—the disorder often progresses subtly and over time due to an accumulation of micro traumas. Hence the term cumulative trauma disorder (CTD).

The carpal tunnel is a busy place with several tendons passing through that help to move digits of the hand. Each tendon is covered by a sheath that provides lubrication so the tendons can easily slide past one another and other tissues in the wrist. Unfortunately, the structure of the wrist did not evolve to cope with the various repetitive motions that can occur in modern life. As the tendons in the wrist slide back and forth, heat can build up, which can stimulate inflammation and reduce the available space in the tunnel. This can place pressure on the median nerve and lead to the symptoms associated with CTS. To make matters more complicated, some people may have a smaller carpal tunnel to begin with. That’s why families can have a history of CTS. Women also tend to have a tighter carpal tunnel, so they may be more prone to the condition.

Generally, taking a break and having adequate rest can allow time for the inflammation to subside. However, many people will continue engaging in repetitive motions, which can lead to very small injuries within the carpal tunnel that may not have a chance to fully heal. Over time, this can reduce the threshold at which inflammation arises, which contributes to why the CTS patient may start experiencing symptoms after a short time when they were formerly able to carry out such activities much longer.

When managing a case of CTS resulting from CTD, the goals of treatment may include reducing inflammation and restoring normal motion to the affected wrist. In addition to manual therapies, physical therapy modalities, and exercise instruction to help the wrist move properly, the doctor of chiropractic may instruct the patient on dietary approaches to reduce inflammation, how to use ice and heat, to wear a nocturnal wrist splint, modify job activities, and take frequent breaks. Additionally, they will examine the full course of the median nerve as it’s common for the nerve to be entrapped at multiple sites, and these will all need to be addressed for a satisfactory result. The chiropractor will also review the patient’s history for potential non-musculoskeletal contributing factors and will work in coordination with allied healthcare professionals, when needed.