When Carpal Tunnel Syndrome isn’t Carpal Tunnel

Carpal tunnel syndrome has become very commonly diagnosed in many office workers. It is common for anyone with pain or tingling in their hand to be told that they have carpal tunnel and that they need to brace their wrist, take pain killers, and, in bad cases, undergo surgery to decompress the carpal tunnel. Yet the surgery for carpal tunnel often fails to fix the problem and many people struggle with this condition for years. But what if their carpal tunnel isn’t really carpal tunnel?

Nerve impingement due to cervical facet dysfunction can cause symptoms very like those seen with carpal tunnel. This means that the pain and tingling in your hands may in actuality be coming from your neck and can often be helped by chiropractic care including adjustments and soft tissue therapy.

So how do you know when you have true carpal tunnel and when you need to consider other causes for the problem? In a true carpal tunnel syndrome the pain, tingling, or numbness in the hand occurs along the palm and affects your thumb, index, middle, and part or all of your ring finger. However, it does not affect the palm of the hand as sensation to your palm is provided by a branch of the median nerve which branches off of the median nerve before it enters your carpal tunnel. This means that if you are having symptoms into your palm the pressure on the nerve is coming from higher up in the arm, rather than from the carpal tunnel. If this is the case you need to explore other areas where the nerves to the hand may become entrapped. This can include the elbow, upper arm, or neck.

References:

Beers, Mark H., et al. (2006). The Merck Manual of Diagnosis and Therapy. Merck & Co.

            Ltd.; Whitehouse Station, NJ.

Netter, Frank H. (2003). Atlas of Human Anatomy; Third Edition. Icon Learning Systems.

            Teterboro, NJ.

Pain in the jaw

 

Temporomandibular joint dysfunction (TMJD) is a group of conditions affecting the jaw. These can include muscular tension, movement problems such as locking of the jaw, and damage to the articular disc in the TMJ. People with TMJD report a wide variety of symptoms including pain in the jaw, clicking or popping when opening or closing the mouth, reduced ability to open or close the mouth, headaches with tension in the jaw, burning or tingling in the face, or tenderness and swelling on the side of the face.

How can a chiropractor help?
Chiropractors can treat tense muscles in the jaw through a variety of soft tissue techniques and manipulate or mobilize the TMJ to break up any adhesions in the joint and restore proper movement. A chiropractor can also evaluate and treat any related problems which are often found in the neck and shoulders when a patient has TMJD. Finally, a chiropractor can provide a referral to a dentist if the problems may be related to oral health.

What can you do to help yourself?
First and foremost, avoid chewing gum or eating sticky, chewy, or exceptionally hard foods. Take smaller bites of food that will be easier to chew. Be aware of your reaction to stress and avoid clenching your jaw or grinding your teeth. Learn relaxation techniques to keep stress from affecting your jaw and avoid activities that aggravate the problem.

References:
Akhter, R., t al. (2004). Association of dietary habits with symptoms of temporomandibular disorders in Bangladeshi adolescents. Journal of Oral Rehabilitation. Vol. 31. Pg. 746-753
DeLany, J., et al. (1997). Temporomandibular dysfunction. Journal of Bodywork and Movement Therapies. Vol. 1(4). Pg. 198-214
DeVocht, James W., et al. (2003). Chiropractic Treatment of Temporomandibular Disorders Using the Activator Adjusting Instrument: A Prospective Case Series. Journal of Manipulative and Physiological Therapeutics. Vol. 26. Pg. 421-451

Pubic Symphasis pain during Pregnancy

Many women experience pain in the pubic symphysis at some point during their pregnancy. This can be felt as mild to severe pain in the area of the pubis which can extend down through the groin or down the inner thighs. The pain tends to be brought on by standing, especially on one leg, sitting for a long time, or moving from one position to another, for example rolling over in bed or going up and down stairs. Some women also experience a clicking in the joint. Women are more likely to experience pubic symphysis pain if they are higher in weight, have a previous history of joint hypermobility or have experienced pubic symphysis pain in previous pregnancies.

If you are experiencing pubic symphysis pain making changes to your daily activities can greatly help with pain. When rolling over in bed or getting out of the car it is important to keep your knees together. Both activities are often easier on a slightly slippery surface. Try putting silk sheets on your bed and sitting on a garbage or grocery bag in the car. This allows you to move more easily from one position to another. When getting into bed it is often easier to get into bed on all fours and then lay on your side rather than sitting on the bed and lifting your legs. When sleeping, placing a pillow between your knees and another under the baby bump can be helpful.
Since climbing stairs is often very difficult it can help to go up the stairs sideways stepping up one step at a time. Try to sit without crossing your legs with your weight evenly on both buttocks and stand with your weight evenly on both feet. If you can avoid a strenuous activity such as prolonged standing, lifting, twisting, etc. DO! If not, try to sit down for tasks that are generally done standing.
A variety of exercises can also be helpful in alleviating pubic symphysis pain. Your chiropractor can help you to learn exercises for pain relief.

Jeffcoat, Heather, DPT (2010). Help for Pubic Symphysis Pain During Pregnancy.
InternationalJournal of Childbirth Education. Vol. 25. No. 3.

Ergonomics and Work Related Musculoskeletal Disorders

Chiropractors often treat desk workers for aches and pains related to improper ergonomics related to their desk set up and how they sit while they work. It is estimated that every year in the United States more than 65% of occupational illness and 13 billion dollars in losses due to decreased productivity can be attributed to these types of injuries. These types of injuries occur most commonly in people with jobs requiring repetitive actions, awkward postures, low levels of physical activity, poor placement of work equipment, high stress, and high work load.
For most people, following a few basic tips can help to make your work space as efficient as possible.

• Computer work should be limited to 20-25 hours per week maximum.
• Avoid repetitive movements as much as possible
• Position equipment for most common tasks in the most easily accessible areas or your work station. For example, if you use the phone a great deal it should be close by and easy to reach.
• Take frequent short breaks throughout the day
• Frequently change positions while working
• Your computer screen should be positioned high enough so that, when looking straight ahead, you are looking at the top 1/3 of the screen, and angled to reduce glare
• The keyboard should be placed so that it is at the level of your hands with your elbows bent to about 90 degrees and resting comfortably on the armrests of your chair. A keyboard tray can be helpful for this.
• You should be able to use both the keyboard and the mouse while keeping your wrists straight.
• Your chair should be able to swivel to allow you access to the entire desk and should have a lumbar support that fits into the curve of your low back comfortably.
• When seated your knees should be level with, or slightly lower than your hips and your feet should sit on the floor or on a footrest.

If your workstation is proving difficult to adjust or these tips are not enough to help you with work related stress on the neck, shoulders, and arms a chiropractor can assist you in a more thorough evaluation of your work space.

References
Boudreau, Luke A. & Wright, Geoff. (2003). Ergonomic considerations for a patient presenting with a work-related musculoskeletal disorder: a case report. Journal of the Canadian Chiropractic Association. Vol. 47(1). Pg. 33- 38
Sizer, Phillip S., et al. (2004). Ergonomic Pain – Part 1: Etiology, Epidemiology, and Prevention. Pain Practice. Vol. 4(1). Pg. 42-53
Sizer, Phillip S., et al. (2004). Ergonomic Pain – Part 2: Differential Diagnosis and Management Considerations. Pain Practice. Vol. 4(2). Pg. 136-162

Tension Headaches

Living in a city, I often see patients complaining of headaches. Many people experience pain around their head that feels like their head is in a vise, accompanied by muscle tightness or stiffness in the neck and shoulders. This type of headache is known as a tension headache and is often caused by stress, a lack of sleep, muscular tension, and/or tension in the jaw.

Tension headaches are more common in women than in men and generally affect people between 20 and 50 years of age. They are a very common condition. In fact, tension headaches and migraines account for 90% of headaches that present to medical doctors in North America. With most of us being affected by tension headaches at some point or another the question becomes, what do we do about them?
Tension headaches generally arise from tension in the muscles of the neck and shoulders or improper motion in the joints of the cervical spine. As a result, chiropractic care can help greatly with this problem. Chiropractic muscle work or registered massage therapy can help relax tight, tense muscles, while chiropractic adjustments can help restore proper motion to the joints in the neck. Beyond physical care a chiropractor can help you with strategies to manage stress and help with relaxation. They can also prescribe exercises and stretching which has been shown to help reduce the frequency of tension headaches.
Quick Tips:
When a tension headache strikes try gently stretching the neck and dropping your shoulders to relieve muscle tension. An ice pack wrapped in a towel and applied to the back of the neck can also help alleviate headache symptoms. The best way to avoid tension headaches is to find ways to reduce the stress in your life by staying active and doing activities that you enjoy.