Wednesday, April 4, 2012

From the files of Dr. Jason Markijohn: Carpal Tunnel Syndrome

Dr. Jason Markijohn
Ask yourself:

Do your wrist and hands ache from overuse?

Do your hands burn, tingle, or feel numb?

Do your hands seem to have less than normal strength?

Do you fumble and feel clumsy when lifting objects?

Do you wake up with your fingers curled and stiff?

Do you have difficulty performing tasks such as buttoning a shirt?

If you answered YES to one or more of the above questions, you may have Carpal Tunnel Syndrome or a related Repetitive Strain Injury (RSI).  Carpal Tunnel Syndrome (CTS) is the most prevalent, least understood, and most ineffectively-treated neuro-musculoskeletal RSI condition.

CTS can be caused by any repetative motion that stresses your upper body.  The increased use of computers and their accompanying flat, light-touch keyboards that allow for high-speed typing, have resulted in an epidemic of injuries to the hands, arms, shoulders and neck.  The increased use of pointing devices like the computer mouse and trackball, which require repeated subtle movements, add to these injuries.

The thousands of repeated keystrokes and long periods of clutching and dragging with the mouse causes chronic irritation to soft-tissues (nerves, muscles, ligaments, fascia, and tendons).  This irritation creates friction and pressure, which eventually leads to small tears within the soft-tissue.  These in turn cause inflammation, decreased circulation, and swelling (edema).

CTS injuries are aggravated by:

Poor posture and body positions
Poor ergonomics (positioning of the chair, mouse, monitor, keyboard, assembly line and so on
Decreased strength due to poor conditioning or injury
Insufficient relaxation/rest time away from the stresses that cause the problem
Excessive force that is required to perform an action
Muscle imbalances

All of these factors place unnecessary, repeated stress upon all the soft-tissues of the neck, shoulders, arms, wrists, and hands.

Problems with traditional treatment methods:
The median nerve courses from our neck all the way down our arm and into our hand.  Traditional treatment methods focus exclusively upon the carpal tunnel located at the wrist.  Research is showing that this traditional emphasis upon the carpal tunnel area is both inaccurate and ignores the greater picture.  Dr. Michael Leahy reported that, in over 500 cases of peripheal nerve entrapment, only two cases involved the actual carpal tunnel.  In the majority of CTS cases, the nerve entrapments acctually occur further up the arm, closer towards the elbow.  Our own clinical research has confirmed these findings.  Conventional treatments rarely address these other entrapment sites, choosing instead to focus solely upon the carpal tunnel region.

From a study of 500 CTS patients done by Dr. Michael Leahy at Active Release headquarters:

* 6% of patients diagnosed with CTS had any significant level of nerve entrapment at the actual carpal tunnel.

* 94% of CTS cases were found to actually be further up the arm and most commonly at the pronator teres muscle.

Treatments for CTS include:

Cortisone Injections:   
Overuse of cortisone causes soft-tissues to thin and weaken, creating a biomechanical imbalance in the kinetic chain

CTS Surgery:
May provide temporary relief from pain, however in many cases new scar tissue grows over the carpal tunnel, which again restricts the median nerve.  Remember surgery should always be the last resort.

Splinting:    
rovides temporary relief, especially at night, but over long term causes:

Decreased levels of oxygen reaching tissues.  Poor oxygen levels are a primary accelerant of scar tissue creation.
Decreased strength in arm due to disuse and muscle atrophy.
Imbalances in body mechanics due to other muscles over compensating for the weaker muscles

Anti-Inflammatory Drugs:    
Useful during acute stages but pro-longed use can cause:

Acceleration of degenerative processes within the tissues
Damage the lining of the stomach and intestines

How and why do we get the results with CTS patients when others fail? We evaluate the entire length of the median nerver from its origin in the neck all the way into your hand for entrapment sites; evaluate all soft-tissue structures in the kinetic chain; adjust any joints that are restricted; active release treatment to affected soft-tissue structures; and give a detailed at home re-hab program to keep the condition from coming back. Call 303-759-5575 today to schedule your appointment and start living pain free!

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