All About Carpal Tunnel
Learn all about carpal tunnel and how to tell if you have it!
Chiropractors Introduce Carpal Tunnel Syndrome
Dr. Ben Boudreau: [00:00:05] So OK, Humpday conversations number 13 carpal tunnel syndrome featuring Dr. Clayton Roach and Dr. Ben Boudreau of Roach Chiropractic Center in Bedford, Nova Scotia. Welcome to the show, everyone. Without further ado, let’s review last week, tonight, last week, we talked about pillows and how pillows are meant to be used to create a better alignment in the spine to supplement your chiropractic treatments, creating a nice 40 degree angle so that your neck can be able to rest after that long day of computer work and forward head postures as well as recover because your body uses that time at night to rest and recover from the stresses throughout the day.
Dr. Clayton Roach: [00:00:49] I know we’ve been harping on this a lot, but the necessity to have that curve in the neck. Is is so crucial because it basically brings to life and allows health to happen from the chest up, because that’s basically the innovation to the arm, the supply which you’re going to see a little more of tonight and how we can play a role of all our talks that we’ve done so far, 13 of them. That’s been the point that we’ve been driving home is the importance of that curve. So definitely important
Bedford Chiropractors YouTube Channel
Dr. Ben Boudreau: [00:01:19] If you missed it, watch the full episode on Facebook or you can catch the full episode on the Roach Chiropractic YouTube page.
Dr. Clayton Roach: [00:01:27] Actually, we got to mention, it’s like if you’re watching this on YouTube today because we usually do the Facebook live and we posted on YouTube, make sure you subscribe to YouTube because then you’re going to see when the new episodes come out. So make sure you hit the subscribe button right at the top for YouTube. If anybody’s got carpal tunnel just right down. Yes. In the comments section, if you’ve been diagnosed with carpal tunnel or you have numbness and tingling in your hands.
Because by the end of this lecture, you should be able to tell yourself, have at least an answer of whether or not it is a carpal tunnel or not, because a lot of people assume that if you get numbness and tingling, the eyes I’ve got carpal tunnel so that I might not be the case is you’re going to find out. So go ahead, Ben.
Dr. Ben Boudreau: [00:02:11] Yes. So true.
What Is Carpal Tunnel Syndrome?
Dr. Ben Boudreau: [00:02:12] Carpal tunnel syndrome is a condition caused by a pinched nerve
Dr. Ben Boudreau: [00:02:17] In the actual wrist. The pinched nerve is usually found in this particular region here, and so if we look at the image furthest to the left on the screen, the x-ray, we can actually see there exactly where that nerve would run through the wrist. And it runs through the center of all of those bones to supply the three first fingers and half of the fourth finger. Now, Dr. Roche just drew that nice big area there, that’s your carpal tunnel.
Dr. Clayton Roach: [00:02:54] And obviously is going to be on the front part of the risk, not the back part of the risk, right?
Dr. Ben Boudreau: [00:03:00] Correct. So there are a bunch of bones, tendons and then one nerve that passes through that area and it’s a really, really tight knit area and so you have to create as much space as possible. But unfortunately, from all of these wrist flexion related activities, as well as wrist extension related activities that we do throughout the day, it closes that space and it causes the nerve to be impinged. And therefore, you begin to develop weakness into the hands where you perhaps drop things or numbness and tingling into those digits there.
Fingers Involved In Carpal Tunnel
Dr. Clayton Roach: [00:03:38] Yeah, so very clearly demarcated here is the area of supply for the medium nerve. OK, so what you’re going to see is you’re going to see the thumb, you’re going to see the index, you’re going to see the middle finger and you’re going to see half of the ring finger typically involved. So many times you’ll see patients and they have, you know, the whole hand. That is not a very typical presentation of carpal tunnel. So we’ve got to look at that specific nerve and where it supplies in terms of being able to diagnose carpal tunnel.
Carpel Tunnel Definition Continued
Dr. Ben Boudreau: [00:04:15] You also have to look at to add to just looking at the center photo there, I’m just looking at the muscle of the actual thumb. It’s supposed to be a nice, beefy muscle that looks similarly to when I flex it this way and it becomes nice and beefy, that muscle will begin to actually atrophy through carpal tunnel syndrome. And so you see in that patient there, they’re sort of missing that nice puffiness of this muscle here in the thumb. Yeah, and that’s due to a true carpal tunnel syndrome. Yeah.
Dr. Ben Boudreau: [00:04:49] Now, obviously, that may not be present in the beginning. Right. So you might have some signs and symptoms that you need to go by. Obviously, you don’t want to wait till you see the muscle dying in that part. But if you have long standing carpal tunnel, for sure, you’re going to start to see atrophy or muscle death in this area, weakness
Dr. Ben Boudreau: [00:05:10] Beginning to drop, things like a sensation, probably some of the first key indications of a true carpal tunnel syndrome.
Dr. Clayton Roach: [00:05:18] One thing I hear about Ben is not being able to tie their
Dr. Clayton Roach: [00:05:21] Button their shirts.
Dr. Clayton Roach: [00:05:22] Yes, a lot of times people have a hard time doing that.
Median Nerve Gets Trapped
Dr. Ben Boudreau: [00:05:26] And of the median nerve, the median nerve gets trapped like I was talking about in our pre-humpday conversation. The median nerve is the eye of the hand. It’s the only nerve of the neck that passes through the carpal tunnel. It originates from the top of that neck there and it passes all the way into the front of your hand. If we look at the image further to the left, the median nerve originates from the C5 level all the way through to the T one level. And so what we’re trying to depict here is that the median nerve originates from many levels up in the neck. And so it’s very important to ensure that those levels have enough space for that nerve to be properly supplied.
Dr. Clayton Roach: [00:06:17] So, Ben, just to confirm, if they don’t have a great curve in the neck and you start to see that that space is not as good as it should be, really, any one of these holes that are going to be narrowed could present itself as carpal tunnel because all these nerves make up that bigger nerve that’s going to supply the hand.
Carpal Tunnel Entrapment Sites
Dr. Ben Boudreau: [00:06:37] One hundred percent. Correct. And this is just one of the sites in which the actual median nerve can be compressed and we call these entrapments sites. And so this would be one of the first entrapment sites in chiropractic. We the neck first to see if there are any entrapments there, and then we begin to move our way more distally down and into the arm to find if we have a true carpal tunnel or if it’s a different type of syndrome presenting as a carpal tunnel. And so the second image just to the right of the first is the elbow. And so another entrapment site for the median nerve as it descends down the shoulder and into the elbow is on the medial aspect, the middle side of the elbow itself.
Carpal Tunnel Diagnosis
Dr. Clayton Roach: [00:07:24] So that when we’re trying to diagnose somebody with carpal tunnel, the first two things that we need to do, it’s kind of a bifurcating diagnosis. One, is it coming from the spine? So here we have carpal tunnel that may be presenting itself as carpal tunnel is really a neck problem if it’s not that. Then we have to go more into what’s called a peripheral nerve, so away from the spine into the arm and looking at these traffic jams where this specific nerve called the median, not medium nerve, I think it auto. Correct. So it’s media. And so where else pass the neck? Is this nerve being impinged upon? So one of these sites is this muscle here called the Pronate or terrorist. So right here, the pronated Terris muscle, that is one of these sites.
Carpal Tunnel Symptoms
Dr. Ben Boudreau: [00:08:21] And it’s interesting that you mention the pronated Tetris because it is one of the more common conditions that we would look into if somebody tells us, oh, I’ve been diagnosed with carpal tunnel syndrome. So in a true carpal tunnel, the patient will lose sensation in all digits. The first three and the three and a half digit, but they will not lose sensation right in this portion of their hand. In a prone industry syndrome, they will lose sensation in this portion of their hand because right before the median nerve enters that carpal tunnel and becomes impinged, it sends off a branch to supply the skin here.
And so we always want to check to see, well, do we have a primary Terry syndrome? Do we have a true carpal tunnel? Because if so, we can rule it out and be able to help the patient with this condition and avoid surgery.
Dr. Clayton Roach: [00:09:16] Let’s explain that again, then. So in true carpal tunnel, the thumb, the index, the middle finger and half the ring finger will have that loss of sensation, but it will spare this beefy part below the thumb. You will still be able to feel that that could be true carpal tunnel if it’s coming from over here in the pronate or terrorist muscle right into the forearm across right here. If the nerve is being pinched there, what presentation are you going to get then?
Carpal Tunnel – Chiropractic Treatment
Dr. Ben Boudreau: [00:09:49] You’re going to get full lack of sensation into the hand, the whole hand, the whole hand, including this nice big part.
Dr. Clayton Roach: [00:09:58] Exactly. So when people are coming in and you’re going to see your medical doctor in, your whole hand is numb. The last thing you want to do is cut this ligament here and have surgery for carpal tunnel. Because it is not going to fix it and then down the road, because they cut this ligament, then you may develop true carpal tunnel because now you’re going to have scar tissue there from the surgery, which is now going to create an impingement here. And now on the surgery caused you to have carpal tunnel. So we need to make that differentiation between progenitor Taris, meaning the muscle that’s compressing the median nerve here.
Or true carpal tunnel here by watching what the hand is doing and what sensation you’re getting, all right. Or you’re not getting. So how many of you have learned something so far? Give us a little bit of a thumbs up here, because this is crucial information and it gives you information that puts you in the driver’s seat when you go see your medical doctor or a physiotherapist or chiropractor because you want to make sure that you’re getting the proper diagnosis. That’s the key, because the diagnosis drives the treatment and the proper treatment drives the outcome in terms of the success you’re going to get.
Chiropractic Treatment Continued
Dr. Ben Boudreau: [00:11:14] Yeah. So since we talked about PRONATED Terrace and I just want to talk about the X-ray further to the right just for a second. There’s a little white arrow and it’s pointing to this Supre Condola bone spur. And so that’s another area where the median nerve can become impinged, where it’s neither true carpal tunnel or pronated syndrome. And so we have to make our way further up the arm and figure out, OK, do we have a super Condola Ridge? Could the actual median nerve become an Penge underneath the ligament that passes through there? And if so, how how is it that we are going to solve this problem?
It’s also an area where the brachial artery, which is the artery that passes down the arm with the median nerve can become kinked. And so people can start to present with fullness into the hands, fullness into the arms and lack of blood flow. And so we always want to make sure that we’re correlating correctly. But the main point here is to say that there are many areas besides the carpal tunnel where the median nerve can impinge, but it presents like carpal tunnel. Yeah.
Carpal Tunnel Origins
Dr. Clayton Roach: [00:12:26] In summary, we need to figure out if it’s coming from the neck or if it’s coming from I’m going to write down a piece here. I’ll it out here. To see if it’s coming from. The periphery meaning away. From the spine. OK, so we call this a spinal impingement, we call this a peripheral nerve entrapment. This is super important because this will dictate the diagnosis, which will dictate your treatment, which will dictate how successful you’re going to be at getting rid of that numbness in the hand.
Dr. Ben Boudreau: [00:13:08] I always like to use the analogy of a hose, right? So if the hose is blocked at the get go, you’re going to have even more sensations down at the bottom. And so you want to be able to work your way back and uncheck the holes. Are the hose at as many places that you can so that it can have a flow that it needs to do its proper job?
How Effective Is Chiropractic Treatment
Dr. Clayton Roach: [00:13:29] All right. So how successful is chiropractic with carpal tunnel?
Dr. Ben Boudreau: [00:13:32] That chiropractic is fantastic when it comes to carpal tunnel chiropractic at three, six and nine months, follow up, increase the patient’s pain pressure threshold. Now, a few weeks ago, we spoke about pain, pressure threshold, and this is the amount of pain that a person can handle when you apply the pressure onto the area. And so in compared to surgery patients, patients who underwent manual therapy, slash chiropractic, had higher pain pressure thresholds at three, six and nine months compared to the same time in post surgical patients post surgical candidates.
Dr. Clayton Roach: [00:14:17] I will say in my experience in doing this for 15 years, the quicker people get in. The better it’s going to be because, you know, after a while, that nerve being in pinch, you start to have nerve death, right? So it’s very hard to bring that back when, you know, the problem’s been there for 10, 15 years. I don’t know why people wait that long, but definitely the sooner the better in terms of any nerve problem to try and get that back.
Populations Prone to Carpal Tunnel Syndrome
Dr. Ben Boudreau: [00:14:46] Yeah, there’s definitely a big point was regaining blood flow to the area. There are a few populations of people as well that are more prone to carpal tunnel than a regular population. For instance, pregnant women are more prone to having carpal tunnel as well because there’s more fluid and inflammation that’s being built up in the body during pregnancy. And so a lot of females, pregnant females, will get that lack of sensation. They’re into the risk because that carpal tunnel just is not big enough and that increased inflammation will cause that sort of numbness and tingling as well. Diabetics, it’s been shown that the increased amount of sugar in the actual blood causes damage to the nerve blood supply. And so it decreases the actual sensation and it causes nerve death. And we call this a neuropathies.
Prone Populations Continued
Dr. Clayton Roach: [00:15:38] Magnesium is seen as a natural muscle relaxer, definitely is able to help regulate your sleep a little bit more like if you take it before going to bed, it can help you relax before you go to bed. So we’re not going to touch on this. You can get it from natural sources. Of course, we talked about dark chocolate, avocados, almonds, tofu, bananas, leafy greens from the last Humpday conversations. If you want a more in-depth conversation about magnesium, we did go more in-depth in the past Humpday conversations.
So, you know, to respect the time of the people that are always with us, you can definitely ask us in the clinic about magnesium and how it might be able to help you. And especially having a good source of magnesium like these supplements are from orthomolecular. So next week, Ben, what are we doing?
Dr. Ben Boudreau: [00:16:25] So I just want to thank everyone for submitting your episode requests a phone call.
Dr. Clayton Roach: [00:16:32] Great. Calling the clinic. Hey, can you talk about this?
Questions For Chiropractors
Dr. Ben Boudreau: [00:16:36] Can you talk about this? Can you talk about that? A lot of the requests that we’ve been getting have been about Dunta, a drum roll, the low back. The questions have been directed more towards conditions in the low back. We just wanted to introduce that will be jumping from the neck, the top right to the bottom next week. And so we’ll we’ll sort of try to keep it small and do a few more episodes into the low back. But I don’t want to reveal yet which condition we’ll be talking about.
We’re sort of going to leave that as a bit of a surprise. But I think you guys should be all intrigued by the fact that we’re jumping into the low back next week because this is along with the spinal column, one of my favourite areas to talk about in terms of the entire column and human body.
Dr. Clayton Roach: [00:17:22] And guys, just and we built this for a reason. So we talked about the neck and we were talking about the x rays and the curve. Now, those concepts have been established and now you’ll be glad to know that there should be a curve that exists in the lower back as well. Right. So we’re going to talk about why that’s important and how that can lead to holes in the lumbar spine to also be compressed and how that can create different symptomatology and different presentation in the lower back and legs and all that stuff.
Questions For Chiropractors Continued
So we’ve got some cool stuff going. Guys, we are here for you. And the reason we’re doing this is because we wanted to connect and have people get this information that maybe can’t see us there far away or for whatever reason that may be preventing them from coming in to see us. We want to make sure that we gave them the knowledge and we give you guys the knowledge to put you in the driver’s seat.
So when you go to appointments, whether it’s your medical doctor, chiropractor, physiotherapist, or that you’re struggling to find answers, we wanted to give you some knowledge that allows you to ask better questions, because with better questions comes better answers. So we don’t want you to be in the passenger and hoping that you get all your answers in a 10-minute appointment at a medical office or whatever. We want you guys to be able to get the answers that you need. So that was the goal of the conversation.
I hope you guys are enjoying these, I know many of you have expressed your gratitude to us. So for that, we are very grateful because obviously with you guys, we wouldn’t be doing this and doing this every Wednesday night, so. The key, again, will stress this, share these episodes, go ahead and just push the share button. If you’re watching this on YouTube, make sure you subscribe to us and that what you can see in future episodes. What else then?
Chiropractic Treatment For Carpal Tunnel Takeaways
Dr. Ben Boudreau: [00:19:14] Yeah, so make sure that you ask all the right
Dr. Ben Boudreau: [00:19:17] Questions, Dr. Oceanus just said, just one of the big takeaways from these Humpday conversations is always look into the condition. I mean, we just presented you guys with one of the biggest kind of keys here to ask the question. You know, yeah, I do still have sensation here. Is it possible that it could be somewhere else? So that’s a big key to ask. When you walk into your office, to your doctor’s office and they think you might be a surgical candidate, you might be a little skeptical.
It’s always good to ask these types of questions. And so because we’re giving you guys this awesome information and something that you guys can take with you offer for many, many years and many moons, we just ask you to do the duty and like and share the post with some of your friends. We don’t care where you shared your private group’s public spaces. We just want more people to know that we’re here and we’re here to help and that every Wednesday night we’re going to continue to provide you guys with some great information.
Dr. Clayton Roach: [00:20:15] All right. So what we’re going to do is we’re going to we’re going to end here again, make sure you share the episode and we will be with you next week. Humpday conversation number 14, talking about Lobach.
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