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Treating Carpal Tunnel and Other Repetitive Strain Injuries Without Drugs or Surgery

[ Wrist injury image ]

By Rick Allen, DC

Overview

Ask yourself:

You may have carpal tunnel or a related repetitive strain injury/cumulative trauma disorder (RSI/CTD). Some form of repetitive stress disorder - mostly carpal tunnel - is now occurring in fully 15 percent of the U.S. workforce. The U.S. Department of Labor reports that CTD's currently account for over 60 percent of workplace injuries. The American Academy of Orthopedic Surgeons estimates CTD's cost $27 billion annually in medical treatment and lost income. According to Newsweek (6/26/95), claims for repetitive strain disorders cost employers some $100 billion annually.

RSI/CTD is epidemic.

Medical treatment focuses on the carpal tunnel, where the median nerve crosses the underside of the wrist. The most common medical treatment is a combination of wrist/forearm bracing and anti-inflammatory medication (steroids or nonsteroidal - ibuprofen, etc.). If that doesn't help, surgery is suggested - cutting the flexor retinaculum across the wrist. While this gives dramatic short-term relief of the symptoms, it can create additional problems:

A better route is conservative treatment: chiropractic, massage, myofascial release, neurolymphatic reflex points, acupuncture, nutrition, specific exercises, and correction of poor ergonomic working conditions. In addition to carpal tunnel, these treatments address related problems, such as trigger points in the muscle of the forearm and neck, vertebral subluxations of the neck, and chronic forward postural strain.

I have successfully treated a number of people with carpal tunnel and other RSI/CTD (including myself). It has been my experience that conservative, non-surgical, non-drug treatment is effective in most cases. It is certainly the route to follow first. Most importantly, it has no unwanted side effects.

In the unlikely event that your case is beyond the body's ability to repair itself with conservative care, the medical/surgical route is still available. If you do not experience some improvement within three weeks, your case may unfortunately be so severe that a neurological consultation is advisable and surgery may be required.

My experience is that even with a difficult case of RSI/CTD, you can expect improvement to start within two weeks. While the course of recovery varies with each case, if both you and your chiropractor perform your healing tasks diligently, you can expect good, lasting recovery within three to four months.

In closing, remember that if you continue the same conditions that led to the injury in the first place, you will be back at square one - in pain and, perhaps, unable to work. As outlined in phase three below, ongoing preventative care is imperative to stay healthy.


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Typical Case Overview

History:

Warning Signs - Complaints by the Patient:

Professional Examination:


Ergonomic Work Station diagram

Features of an Anatomically Friendly PC Station


Conservative Treatment:

Phase 1 -- Acute phase (first one to three weeks):

  1. Rest the hands and wrist. Minimize or eliminate the activity that is causing the problem.
  2. Only if absolutely necessary, rest with cock-up splint worn all day and night for up to three weeks.
  3. Cryotherapy - Ice massage of the inflamed area.
  4. Chiropractic manipulation of the shoulder, neck, forearm, wrist and hand for subluxations.
  5. Nutritional supplementation: Start a good, natural multi-vitamin and multi-mineral supplement each day and an additional B-complex supplement.
  6. Wean patient from NSAIDs (nonsteroidal anti-inflammatory drugs), such as ibuprofen, etc.
  7. Replace with natural anti-inflammatory herbs (I prefer a combination called PSI from NF Formulas in Wilsonville, OR), natural proteolytic enzymes (bromelain is the most common and is an ingredient contained in PSI), and beneficial omega-3 oils (salmon and a borage/flax combination).
  8. Have workstation evaluated for proper ergonomics and have corrections made. If necessary, order protective devices.

Phase 2 - Post-acute phase (next two to four weeks):

  1. Continued rest or modified work, as necessary, to prevent aggravation.
  2. Chinese "spooning" as tolerated to improve blood flow and break superficial adhesions of the skin and underlying fascia.
  3. Pre-manipulative physiotherapy - ultrasound is most common.
  4. As tolerated, extensive release of the deeper soft tissues - muscles, tendons, and tendon sheaths - with massage, active muscle stripping, trigger point therapy, transverse friction massage.
  5. Continue chiropractic manipulation of the shoulder, neck, forearm, wrist and hand for subluxations.
  6. Complementary acupuncture treatment of the arm and supportive structures of the neck and back.
  7. Continue nutritional supplementation.
  8. Add glucosamine hydrochloride or sulfate and chondroitin sulfate, which are building blocks for healthy connective tissue. (GSCS NF Formulas is a good choice, call 800/547-4891.)
  9. At home, rub salve on the arms to promote circulation and reduce inflammation. I use one specially made for treating this type of injury. It is available from Kate Montgomery, LMT (www.sportstouch.com).
  10. As adhesions and tenderness of the hands and wrists diminishes, start home exercises specifically designed to strengthen the extensor muscles of the forearm. This will counterbalance the excessive strengthening of the flexor muscles that occurs with typing, hammering, etc. The best exercise aid I have found is the Flextender Glove by Balance Systems (www.repetitive-strain.com).

Phase 3 - Ongoing Preventative Treatment:

  1. Self-massage and treatment of trigger points of the forearm and hand. Kate Montgomery has a good 12-step program that I endorse (www.sportstouch.com).
  2. Stretches and strengthening exercises while at work, much the same as wearing a hard hat and safety glasses for prevention of injury. This keeps the muscles in proper balance.
  3. Continued nutritional support, including omega-3 oils and GSCS.
  4. Continued monitoring of ergonomic conditions.
  5. Regular massage and chiropractic care to prevent buildup of adhesions and subluxations.

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References:

Background about the extent of the problem

Treatment, including myofascial release techniques

Nonsteroidal Anti-inflammatory Drugs (NSAIDs - ibuprofen, etc.) - dangers and alternatives

Workstation ergonomics

Dr. Rick Allen is a chiropractor, massage therapist and dance student who splits his time between Portland, Oregon and Trout Lake Washington. Dr. Rick welcomes your questions and suggestions for future articles. However, he cannot make specific diagnoses or treatment recommendations unless you visit him in person. He can be reached by phone at 503-257-1324 in Portland, 509-395-0024 in Trout Lake, or toll free at 1-888-247-3248, email or on the World Wide Web: www.CascadeWellnessClinic.com

DISCLAIMER: The information included in this website is meant to encourage thinking concerning choices of care for and insight pertaining to possible causes of various problems. It is not a prescription for or diagnosis of any disease or condition. Suggestions are based on the assumption by the writer that a thorough examination was done previously and the reader is under care by a healthcare professional. This information is not a substitute for a live doctor.

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Cascade Wellness Clinic