Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is a commonly misdiagnosed condition. Often, the source of the problem is not in your hands at all. Instead, the problem often comes from neurological irritation in your neck (aka cervical spine).

Especially if you experience CTS and also have neck pain, shoulder pain or headaches, a unique approach known as the Blair procedure can help.


What is Carpal Tunnel Syndrome?

True Carpal Tunnel Syndrome occurs when the median nerve in one of your wrists becomes compresses. This can be caused by repetitive use injuries (e.g., typing), arthritis, or fibrosis produced by old injuries.

Now, here is one of the most important things to understand about true carpal tunnel syndrome: the burning or numbness in your hand will affect your thumb, index and middle finger on the palm-side of your hand only.

Too often, any pain, numbness or tingling in the hands (especially at night) is quickly diagnosed as carpal tunnel syndrome. With the vast majority of cases, however, this is NOT the pattern that most people describe.

  • Pain in your ring or pinky fingers is NOT carpal tunnel syndrome
  • Pain in your middle finger only is NOT carpal tunnel syndrome
  • Pain in your fingertips or your whole hand is NOT carpal tunnel syndrome
  • Pain across the back of your hand (even if it is your thumb and index finger) is NOT carpal tunnel syndrome
  • Finally, pain in both your hands (even if it is on both hands and follows the correct pattern) is probably NOT carpal tunnel syndrome either. (It is most likely double-crush syndrome that we will describe later.)

(Side note: We once had a client in our offices, who had carpal tunnel surgery on both hands because they experienced tingling in their ring and pinky fingers. Of course, the surgery did not improve their symptoms at all. The reason is that this particular nerve does not travel throbs the carpal tunnel! Needless to say, we were NOT impressed because their neurologist and surgeon should have known better. This is basic neurology!)


Upstream and Downstream Effects

Think of a river that flows from north to south (like the Mississippi River). Let’s say that you have an upstream blockage toward the north. The result will be reduced downstream flow.

This analogy is useful when it comes to understanding the cause of carpal tunnel syndrome. A proper diagnosis of CTS requires specialized diagnostic tests known as nerve conduction velocity (NCV). In brief, a series of needles are inserted into the forearm, wrist and then fingers to see if there is a decrease in nerve activity along the course of the median nerve.

If you have true carpal tunnel syndrome, there will be a sudden decrease in nerve activity as the nerve passes through your wrist.

Even then, there is much more to the story. Think back to the idea of upstream and downstream flow. Compression at your wrist often accounts for only 10% of the total (downstream) flow. Alternatively, compression at any point upstream can produce downstream effects that can produce pain, numbness, burning or tingling in your hands even though the actual problem is not in your wrist at all.


Double Crush Syndrome

This is a phenomenon known as double crush syndrome, where upstream nerve irritation produces downstream pain. When this occurs, the carpal tunnel may only be a small part of the problem.

  • Wrist = 10%
  • Elbow = 15%
  • Shoulder = 25%
  • Cervical Spine (neck) = 50% (!)

(Note: These are not exact percents, but illustrate the principle).

Especially if you experience symptoms in both hands, odds are that you don’t actually have carpal tunnel syndrome in both hands. Instead, it is far more likely that you have an upstream problem in your neck that is producing downstream effects into both of your hands. This is a condition known as a cervical radiculopathy, or more appropriately a cervical myelopathy.

What this means for all people with any type of burning, numbness, pain or tingling in your hands (even if you have been diagnosed with carpal tunnel syndrome) is that the health of your neck probably plays a big part of your condition, and if you want to resolve the cause and not just treat the symptoms, you will want to work with someone who specializes in disorders of the cervical spine.


The Blair Approach to Carpal Tunnel Syndrome

Especially if you want to avoid surgery and taking medication, the Blair technique is a natural, non-surgical approach to healthcare than can help. The Blair technique is a specialist division of general chiropractic that focuses on disorders of the craniocervical junction (CCJ).

Unlike general spinal manipulation, there is no popping, twisting or neck cracking with the Blair procedure. The approach first uses a series of advanced diagnostic scans, either digital articular X-rays (DAX) or CBCT scans. These tests show the exact location, direction and degree of vertebral involvement that produces narrowing (aka cervical stenosis) that disrupts the normal function of your nerves.  The procedure then involves a series of precise and personalized corrections (like fitting a key in a lock) that help to restore normal motion and stability through the joints in your neck. This allows your body to do what it is designed to do: heal itself.

Even if you have tried general chiropractic and physical therapy, the Blair procedure is remarkably different.

If you are looking for a chiropractor in Spokane, visit our home page more information. To schedule a new patient appointment with our Mead (north Spokane) or South Hill offices, complete a new patient request form here or call us direct at 509-315-8166.