Is It Carpal Tunnel Syndrome or Double Crush Syndrome?
The wrist contains a space that nine tendons and the median nerve run through from the forearm to the hand. This space is referred to as the carpal tunnel. The median nerve is located under the largest ligament that runs through the carpal tunnel. This ligament holds the median nerve and the remaining tendons in place. If pressure builds in the carpal tunnel due to inflammation of the tendons, fractures, arthritis or dislocations, the median nerve can become compressed (carpal tunnel syndrome), which can cause weakness, pain and numbness in the thumb, index and middle finger. This condition is common in activities where the hands are used, such as typing or writing.
Double crush syndrome occurs when the median nerve is irritated at two different location along the nerve path. To understand this syndrome, let’s take a look at the nerves in the body. The nerves are contained in the spinal cord. From the spinal cord, a nerve leaves the spine and travels to the different locations in the body, including the hands, feet, wrists, ankles, etc. Unlike carpal tunnel where the median nerve becomes irritated in the carpal tunnel, double crush syndrome occurs when the nerve is irritated in another location, such as the neck. This irritation can become so severe that the nerve can be easily damaged in another location such as the wrist.
Unfortunately, carpal tunnel syndrome can be misdiagnosed if the physician does not complete a neurological examination using proactive tests. Provocative tests can help determine if the irritation is caused by irritation of the median nerve or an irritation of a cervical nerve root. If the physician cannot determine the cause of the patient’s symptoms, an EMG (electromyogram) may be ordered. An EMG records electrical activity in the nerve cells to determine if there is nerve dysfunction. The procedure is done using a needle electrode that is inserted into the muscle to measure the electrical activity in the nerve or muscle.
There are several noninvasive therapies that can be used to ease the pain associated with both conditions. Some of these therapies include:
- Anti-inflammatory medications may be prescribed to relieve pain and decrease inflammation. These anti-inflammatory medications block Cox-1 and 2 enzymes that cause inflammation in the body.
- The patient may need to make changes to the way they use their hands, wear a wrist splint and use ergonomic aids, such as an ergonomic keyboard and an ergonomic wrist rest.
- Physical therapy to strengthen the muscles and tendons in the neck, hands and wrists and to increase mobility. The physical therapist will lead the patient through exercises to help the tendons glide more smoothly through the carpal tunnel. Another technique used is ultrasound. Ultrasound sends pulsating sound waves into the carpal tunnel to promote healing and decrease pain and inflammation.
- Chiropractic treatment can be used to ease the symptoms of double crush syndrome and carpal tunnel syndrome. A chiropractor will manipulate the upper spine to correct misalignments of the body that may be causing your pain, tingling and numbness in your hands. Additionally, manipulations can be done to the forearm, elbow, and wrist to correct restrictions that could be causing pressure to the nerve.
- Pulsed cold laser therapy is another treatment that can be used to treat both carpal tunnel syndrome and double crush syndrome. This therapy uses low level lasers to reduce pain and inflammation by increasing metabolism at the cellular level, thus increasing the body’s natural healing ability.
Carpal tunnel syndrome and double crush syndrome cause numbness, tingling and pain in the wrist, hand and fingers. Because both of these syndromes have the same type of symptoms, a misdiagnosis is possible. Finding a doctor who is knowledgeable on the proper diagnostic techniques is essential to getting an accurate diagnosis.
Our chiropractor specializes in carpal tunnel and other chronic pain conditions. Once a proper diagnosis is made, a treatment plan will be recommended. This treatment plan may include rest, physical therapy, chiropractic manipulations and cold laser therapy.
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