One area to consider is driving. When it comes to carpal tunnel syndrome pain most individuals think about keyboard typing, as the source of arm, wrist, and hand pain. This is true, but carpal tunnel can develop from:
Any repetitive motion
Bending at the wrist
Vibrations going through the wrist
Long-distance truckers, those who drive for business or regular long pleasure trips on winding mountain roads can take a toll on the muscles, tendons, ligaments of the arms and hands. Combining a regular job, stacking, scanning, lifting, and typing away most of the day, then long commutes, and weekends driving around, an individual can begin to present with arm, hand, and finger pain.
Signs and Symptoms
Carpal tunnel can sneak up when least expected. Most individuals begin to feel a burning, tingling, or numbness in the thumb and first two fingers, and for some, the palm, as well. Discomfort or pain usually presents at night and in the morning. If the condition becomes worse, individuals often feel the need to shake out the hand or wrists, trying to bring relief from the pain and tightness. It can affect one hand or both hands. The pain can continue to increase and climb up the arm. Then normal tasks like pumping gas or writing with a pen become unbearable.
Carpal Tunnel Syndrome
The median nerve controls the sensations to the palm, the thumb, and the four fingers of the hand. The nerve runs through a small passageway in the wrist called the carpal tunnel. Swelling or thickening of the tendons narrow the tight space and irritate the nerve.
There are different ways to diagnose the condition. To avoid damaging the median nerve, it is important to get a diagnosis as early as possible.
Apply pain ointment/cream before driving and keep on hand
A chiropractor is a highly trained specialist in the entire body’s musculoskeletal system. Chiropractic treatment can help avoid developing chronic pain and surgery in the future. Correcting subluxations and restoring optimal blood and nerve energy flow in the arms, hands, and rest of the body is the objective. Chiropractic investigates and treats the compression of nerves anywhere in the body, including the forearm and wrist. Realigning the spine, shoulder, elbow, and wrist, blood circulation and nerve impulses will flow freely once again. A chiropractor could also recommend:
The treatment plan will depend on each individual’s unique case and circumstances. At Injury Medical Chiropractic and Functional Medicine Clinic, we care about each individual’s situation and are committed to doing whatever it takes to alleviate the pain and get the individual back to optimal health.
Soluble and Insoluble Fiber
All plant-based foods are generally a combination of soluble and insoluble fibers. Soluble fiber dissolves in water and turns into a gel substance when it passes through the gastrointestinal tract. Foods high in soluble fiber include:
Insoluble fiber does not dissolve in water. The term roughage generally refers to this type. Roughage speeds up transition time in the digestive system. This is the basis for eating more insoluble fiber, to prevent constipation by helping food move through the system. Foods high in insoluble fiber include:
Whole wheat bread
Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
Savage, Robert. �Re: Carpal Tunnel syndrome and work.��Journal of hand surgery (Edinburgh, Scotland)�vol. 30,3 (2005): 331; author reply 331. doi:10.1016/j.jhsb.2005.02.007
Haas, DC et al. �Carpal tunnel syndrome following automobile collisions.� Archives of physical medicine and rehabilitation�vol. 62,5 (1981): 204-6.
Shoulder and arm pain can be debilitating, especially when there is no obvious cause or injury that needs to be treated. A rare condition known as brachial neuritiscan cause spasms along with pain down the arm, followed by numbness, tingling, and weakness. If not diagnosed and treated early, the symptoms can worsen with time. The pain experienced can be described as sharp, searing, and shooting. Brachial neuritis can be intense and disabling when it presents for hours and even days.
Utilizing a chiropractic approach, shoulder and spinal adjustments can provide relief and a faster healing/recovery from the inflammatory condition. Individuals experiencing shoulder, arm, and possible hand pain should consult with a chiropractor about a potential home and clinic treatment plan to improve their condition.
Medical History and Examination
The process of diagnosing brachial neuritis involves an individual’s medical history and physical exam. More complicated cases could require imaging studies and electrodiagnostic tests. The first steps in diagnosing the cause of shoulder and/or arm pain include:
Information will be collected on an individual’s:
Recent illnesses or injuries
How and when symptoms began
A chiropractor will palpate or inspect by feeling the neck, shoulder, and arm for irregularities. Then they will examine the range of motion, strength, and reflexes. If the individual’s history and physical exam suggest that the cause could be brachial neuritis or other condition involving the nerves, imaging studies, and diagnostic tests could be required to evaluate further.
Symptoms of Brachial Neuritis
The condition is also known as Parsonage-Turner Syndrome. It affects the brachial plexus, a set of nerves that run from the neck and upper back to the shoulders. The condition usually affects only one side of the body and presents randomly.
What happens is the nerves become inflamed.
Inflammation can be triggered through an autoimmune response. This is often the result of an infection, surgical procedure, or other internal stressors. The inflammation can lead to severe debilitating shoulder pain over a few days.
This also leads to long-term numbness, weakness in the shoulder and arm.
The pain becomes worse with movement.
Typically, the pain goes away on its own within a few days.
Numbness, weakness, or tingling in the shoulder or arm continues.
Over time the symptoms begin to worsen and, if left untreated, could lead to muscular atrophy of the arm.
The pain and weakness can make it difficult to move the arm, leading to decreased strength.
Symptoms can last up to a year or more.
This is why individuals have to find ways to strengthen their shoulder/arm despite the condition.
Treatment requires a pain management program until the pain subsides. Once the pain is manageable, chiropractic, physical therapy, exercises, and stretches could improve mobility and strength. Chiropractic can provide relief and tools necessary to prevent the worsening of symptoms. Chiropractic helps to:
Chiropractic manipulation will ensure that the nerves near the brachial plexus do not become compressed, but if they are, then chiropractic can be utilized to decompress/release them. In addition, trigger point release and massage can help alleviate the tension in the surrounding tissues of the arm and shoulder.
A chiropractor will educate the individuals on effective pain management techniques for home, including ice/heat therapy and stretching exercises. These techniques will help restore the proper alignment and flow of the spinal vertebrae, nerves, and muscle tissues, allowing the body to heal quickly, naturally, and more effectively.
Chiropractic Shoulder Pain Treatment
Feinberg, Joseph H, and Jeffrey Radecki. Parsonage-turner syndrome. HSS journal: the musculoskeletal journal of Hospital for Special Surgery vol. 6,2 (2010): 199-205. doi:10.1007/s11420-010-9176-x
Keyboards and mice come in all sorts of colors and styles, which is great but for those that work on a computer for a job, using the right type is essential to prevent injury keeping the hands, wrists, and arms healthy and moving.
Overuse can cause painful musculoskeletal disorders like:
From the beginning of this design, there was a realization that angling and splitting the keys would reduce the bending of the hands. The first split keyboard typewriter was manufactured in 1886.
The idea of splitting and angling the keys was implemented into ergonomic keyboard designs with the alphanumeric keys being separated at an angle into two sloped sections. For a� non-touch typist, this can be difficult to use, as some keyboards only angle the keys without splitting into halves.
The split design reduces the sideways bending of the hand but also important is the reduction of vertical bending.
However, this can be overcome by taking some simple steps like:
Flattening the keyboard feet on the desk can keep the hands flat
Putting the keyboard on a vertical tilted tray can also help improve the hands’ posture
Keyboards are available in left and right-handed styles
Choosing a Mouse
The shape along with the location of the mouse in relation to the keyboard is important for maintaining a healthy hand posture. Here are some considerations when choosing a mouse. The mouse buttons should:
Have easy clickability
Is easy to move around/feels natural
The screen cursor should move accurately with your movements
There are mice with programmable buttons allowing you to control additional functions. Important things to check:
Make sure the size and shape of the mouse feels natural in your hand
Hold the mouse in a neutral position meaning your hand should not be bent up, down or sideways
Position and operate the mouse with your upper arm relaxed and close to your body, and don’t reach too far forward or too far out to the side
There are keyboards with a separate numeric pad that allows the mouse to be located closer to the keyboard. Some keyboards include a cursor positioning device like a trackball, touchpoint or touchpad. These types eliminate having to reach for a mouse. However, it is a good practice to mix it up using the keyboard for certain operations and the mouse for others. This allows different muscles and ligaments to work while the others take a break.
The Ideal Setup
All keyboards and mice are designed differently. The key is to find well-made products that are built with ergonomic injury prevention as the focus. You can use trackballs, touchpads, and pen mice instead of a regular mouse.
Find what works for you, is ergonomic, comfortable and easy to use and will keep your hands in a neutral posture. If you do a lot of typing and mouse movement, your hands are going to get tired even with top designed keyboards and mice. Take frequent short rest and stretch breaks to let your muscles recover. The stretching exercises should include the:
Upper back muscles
Working like this will protect you against over-use injuries.
Carpal Tunnel Chiropractic Treatment
Chiropractic care is one of the most common forms of treatment for carpal tunnel syndrome. Foremost, a doctor of chiropractic will evaluate the extent of the condition as well as diagnose the individual to determine any underlying cause behind the condition. Through a series of chiropractic adjustments and manual manipulations, the hand, wrist, and arm are adjusted to reduce the pressure around the median nerve, and ultimately reducing the symptoms.
Carpal tunnel syndrome, or CTS, is a condition where the nerve that runs from the forearm into the hand gets compressed. Carpal tunnel can cause significant pain and result in numbness that makes using your hand practically impossible.
Carpal tunnel affects�approximately 3% of the population. Carpal tunnel sufferers, fortunately, there are effective treatments that do not require surgery. Chiropractic care can help relieve the pain of carpal tunnel, and can often improve mobility and range of motion in the process.
What is it?
The term �carpal tunnel� refers to an actual tunnel created by ligaments and bones in the wrist. Tendons and median nerves travel from the forearm through the carpal tunnel in the wrist and into the hand. When the median nerve becomes compressed inside the carpal tunnel�usually due to injury or inflammation�it can lead to the symptoms associated with CTS.
The exact cause of CTS is not always easy to identify, but there are many factors that can play a role. A family history of CTS makes it more likely that you will develop the condition. Repetitive work, such as a job on an assembly line, is known to increase the risk of CTS. Wrist injuries can also cause carpal tunnel. There are other contributing factors that are not as obvious, such as pregnancy, menopause, and dialysis.
The first signs of carpal tunnel often include a feeling of pins and needles in the wrist, hands, and fingers. You may notice some numbness from time to time, especially after using the wrist in a way that causes compression�like performing a task over and over at work.
Over time, the symptoms can become more severe. Eventually, carpal tunnel can lead to a loss of coordination with the thumb, then other digits. Pain may not be significant at first, but tends to get worse and the condition progresses.
Chiropractic Can Help
Standard medical treatments for carpal tunnel include using anti-inflammatory drugs, refraining from using the wrist/hand, wearing a splint and eventually surgery. While these treatments can sometimes be effective, the risks associated with surgery are significant. Carpal tunnel surgery may or may not fix the problem, and as with any surgery, can sometimes cause more issues than it helps.
Learning to Protect Yourself
Chiropractic care offers a safe alternative to standard medical care, one that is non-invasive and minimizes the need for medications and their potential side effects. Chiropractic treatments for carpal tunnel can help to reduce inflammation and minimize pain. But chiropractic goes further than just treating the symptoms�it can also help you avoid aggravating the condition so that it can heal.
Chiropractors are trained in proper movement and ergonomics. Your chiropractor can help you understand what you are doing that is causing the carpal tunnel to begin with. He or she can also advise you on ways to adjust your movements to protect your wrists moving forward. You may be able to learn new ways of doing things that will allow you to achieve your goals without risking injury.
One of the fundamentals of chiropractic care is improving strength and mobility to aid in healing and protect from further injury. Your chiropractor can guide you through exercises to make you stronger. Once you know how to do the exercises, you can do them at home to continue to gain strength.
Schedule An Appointment
Carpal tunnel sufferers, don’t wait any longer and contact us to schedule an appointment. We will get you the relief you need!
Piano players will sit or stand at a piano or keyboard, often in the same position for hours. A clarinet player must keep their head, neck, and jaw in a precise position in order to play properly. A guitarist must sit for long periods while holding the guitar in a certain position while moving their fingers over the frets in a very precise manner.
In other words, musicians put their bodies through some vigorous training. They practice for hours a day and engage their bodies in repetitive motions for long periods of time.
It’s no wonder that many musicians complain of headaches, migraines, carpal tunnel, clicking jaw, numbness in the fingers, and back and neck pain!
Some of this pain can be debilitating and make it more difficult for them to perform their normal activities. Many live with chronic pain.
There was a time when these conditions were considered to be just a part of playing an instrument and the musician would push through the pain. However, many are turning to chiropractic and are enjoying not only a pain-free life but improved performance as well.
The Way Playing an Instrument Affects the Body
Some doctors liken musicians to athletes � instrumental athletes. They do have very similar practices such as practicing for hours a day so that they can perfect their abilities and skills. And like athletes, they also experience certain break downs within the body.
Posture is a common malady as the musician may stand or sit a certain way in order to play their instrument. This prolonged activity can lead to imbalances in the spine, pelvis, and other parts of the body.
When the body is not in balance, it cannot function as it should. Organs are affected and other the body may try to make accommodations for the imbalance which only exacerbates the problem.
This is further compounded each time the musician plays their instrument because by doing so they are consistently underworking and overworking certain muscles. This can lead to further imbalance.
The muscles that are worked, the ones used to play the instrument, get shorter, tighter, and stronger as scar tissue forms. By contrast, the underworked muscle groups stay underdeveloped and get weak. This muscular imbalance puts a great deal of stress on the spine and other joints in the body like the fingers, wrists, and elbows
They may also experience Repetitive Strain Injury or RSI. This condition is often quite painful and is concentrated in the soft tissues, nerves, tendons, and muscles.
These areas may become painful or inflamed when performing repetitive activities, pressing against hard surfaces, vibrations, awkward sustained positions, and forceful exertions. This causes the body to become out of alignment but also impacts the function of the skeletal system, nervous system, and muscular system.
Chiropractors are very good for musicians because the can assess misalignments in their spine and make adjustments. When proper original alignment is stored to the body, it begins to function properly. This leads to a decrease in pain and other symptoms that may be experienced due to the long hours of playing an instrument.
Musicians also benefit from chiropractic because it can make them better at what they do. When the pain is decreased or eliminated and the other symptoms are relieved, it is easier to play.
When the spine is in proper alignment and the body is balanced, the musician will experience a boost in energy, their muscles will not fatigue as quickly, and their muscles will be more relaxed. With all those benefits, it�s no wonder that chiropractors and musicians make beautiful music together.
De Quervain’s Tenosynovitis, also called �washerwoman sprain,� is a condition of the hand that typically affects people who do continuous, fast, repetitive movements. The patient can experience a sudden onset of the condition or it can be gradual, beginning with tenderness in the thumb area and slowly progressing. It can restrict activity, but it doesn�t have to be a long-term disability. Chiropractic care can help relieve the symptoms of De Quervain�s Tenosynovitis and the hand can return to normal function.
What Is De Quervain’s Tenosynovitis?
De Quervain’s Tenosynovitis is a condition affecting the thumb side of the wrist. It is a very painful condition that makes many everyday activities difficult or impossible. Many activities like playing golf, lifting a child, garden work, and racket sports can worsen the condition.
What are the Symptoms ofDe Quervain’s Tenosynovitis?
There are several distinctive symptoms of De Quervain�s tenosynovitis which include:
Pain near or at the base of the thumb
Difficulty moving or controlling the thumb and wrist when doing activities that involve pinching or grasping
Swelling near or at the base of the thumb
A �catch� or �sticking� sensation when moving the thumb
If the condition is allowed to progress or goes untreated it can involve the forearm and entire thumb, causing pain and swelling in those areas. The pain and symptoms can be exacerbated by movements that involve the wrist and thumb. The symptoms can last for a long time, weeks or even months.
What causes De Quervain’s Tenosynovitis?
The exact cause of De Quervain�s Tenosynovitis is not known, but the condition is commonly associated with chronic overuse of the wrist. There are tendons that connect the wrist and lower thumb, enabling movement like grasping, gripping, pinching, and wringing. The tendons slide through a sheath as they facilitate the movement. Over time, the sheath can swell and thicken which inhibits the amount of the tendon�s movement. When the movements are repetitive, it can cause irritation of the sheath, resulting in inflammation.
Who is at Risk for De Quervain’s Tenosynovitis?
Research has identified several groups that are at risk for developing De Quervain�s Tenosynovitis:
30 to 50 years of age with a higher concentration statistically around 40
African ethnicity or descent
Caring for a child or baby
Works at a job that involves repetitive wrist and hand motions
This condition has typically been considered to be one that affects people who are middle-aged. However, with the popularity of texting, many young people experience symptoms of De Quervain�s. In one study, more than half of students who texted extensively were labeled positive for De Quervain�s.
What are the Treatments for De Quervain’s Tenosynovitis?
Treatment for De Quervain�s Tenosynovitis include:
Resting the affected thumb and wrist
Bracing or immobilization
Ice to the affected area
Anti-inflammatory medications like ibuprofen and naproxen
If standard treatment is not effective it may be necessary to seek medical attention. If the condition is severe or chronic, the doctor may inject corticosteroid directly into the tendon sheath. Surgery for De Quervain�s is not common, but it may be deemed necessary in order to release the thumb. The speed of healing and the�degree of normal use of the thumb depends on the treatment chosen and if the activity that exacerbates the condition is stopped.
Can Chiropractic Help De Quervain’s Tenosynovitis?
A chiropractor may recommend rest, ice, and bracing for a patient with De Quervain�s Tenosynovitis. Upon reviewing the patient�s lifestyle and habits, he or she may also advise ergonomic changes, modification of activity, and reduce exposure to positions that exacerbate the symptoms. Soft tissue therapies may be used to quickly bring relief to the soft tissue, minimizing the inflammation and pain. As the pain decreases, the chiropractor will recommend specific strengthening and stretching exercises that involve the wrist, thumb, and forearm.
With regular care and modification to activities, the condition can be healed and full mobility of the thumb and wrist can be restored.
In all cases, Orthopedic hand surgical referral is required
Colles fx: m/c d/t FOOSH+pronation. m/c inOSP/elder women. Rare in men and if occurs need DEXA to avoid hip Fx etc. Young pts: high-energy trauma. Typically extra-articular.50%-cases show Ulna styloid (US) Fx.
Imaging: x-rad is sufficient, CT in complex Fx, MRI helps with ligament tears and TFC.
Rx: if extra-articular and <5-mm distal radius shortening and <5-degree dorsal angulation closed reduction+casting is sufficient. ORIF in complex cases.
�Image Dx: distal rad impaction/shortening,dorsal angulation of distal fragment, carefully examine if intra-articular extension, 50% US Fx
Smith Fx: Goyrand in French literature. Considered as reversed Colles, otherwise almost identical, I.e., 85% extra-articular, 50%US Fx, OSP/elderly women, young pts-high-energy trauma. Differences: mechanismFOOSHwith flexed wrist thus m. Less frequent.
Imaging steps: (see Colles Fx) C
Complications: similar to Colles Fx
Rad Dx: 85% extra-articular with volar(anterior) angulation of the distal fragment,radial shortening. Carefully examine cortical breach suspecting intra-articular extension that can be named as Smith type 2 or Reversed Barton Fx (next)
Rx: similar approach as in Colles.
Barton fx: FOOSH, impaction of distal radius similar to Colles but the Fx line extends from the dorsal radial aspect into radiocarpal joint resulting with dorsal slip/dislocation of the carpus.
Imaging: 1st sept x-radiography often with CTto examine intra-articular Fx extension and operative planning
Rad Dx: distal radius Fx extending from dorsal into the radiocarpal joint with a variable degree of displacement, the proximal slip of the carpus
If Fx line extends from the volar aspect into the wrist joint named Reversed Barton aka Smith type 2 (above bottom image)
Complications: similar to all distal radius Fx
Rx: operative with ORIF
Chauffeur’s/backfire Fx aka Hutchinson Fx: intra-articular Fx of Radial styloid. The name derives from the time when the car had to be started with a hand crank that could backfire inducing wrist dorsiflexion and radial deviation.
Imaging: x-radiography is sufficient. CT may be helpful if Fx not readily shown by x-rays.
Rx: operative with percutaneous lagscrewin all cases d/t intra-articularnature
Die-Punch Fx: impaction Fx by the Lunate bone into distal articularLunate fossa of the Radius. IntraarticularFx. Derives its name from a technique to shape (impress) a hole in industrial machining “die-punch.”FOOSH injury.
Imaging: 1st step x-rays, may be equivocal d/t subtle depression of the Lunate fossa then CT scanning is most informative.
Rad Dx: impacted lunate fossa region with intra-articular Fx extension. This can present as a comminuted Fxarticular Fx of the Distal Radius.
Rx: operative d/t intra-articular Fx
Construct arcs of Gilula when evaluating carpal injuries. An Important step required to avoid missing subtle changes in carpal alignment and cortical continuity
Scaphoid bone Fx: m/c Fx carpal bone. D/tFOOSH wrist extended radially deviated. Location of Fx is most important to prognosis: Waist-m/c location (70%). May have 70-100%chance of AVN. Proximal pole Fx: 20-30% with a high risk of non-union. Distal pole-10%shows better prognosis. Distal pole Fx is m/c in children. Key clinical sign; pain in the snuffbox.
Imaging: 1st step-x-radiography but 15-20%missed d/t occult Fx. Special views required. Thus MRI is the most sensitive and specific for early occult Fx. Bone scintigraphy has98/100% specificity & sensitivity esp. 2-3 days after the onset. Key rad. Dx: Fx line if evident, displacement and obscuration of scaphoid(navicular) fat pad, examine for scapholunate dissociation. If proximal bone appears sclerotic-AVN occurred. MRI: low on T1 & high on T2/STIR/FSPD d/t bone edema, a�low signalFx line can be noted.
Rx: Spica cast should be applied if clinically suspected even w/o x-ray findings. For waistFx-cast for 3-mo for prox pole 5-mo immobilization. ORIF or percutaneous pinning with a Herbert screw.
Scapholunate Ligaments Dissociation
SNAC wrist: scaphoid non-union advanced collapse. Often d/t non-union and dissociation of scapholunate ligaments (SLL)with progressive radiocarpal and intercarpalDJD. The Proximal scaphoid fragment is attached to Lunate with distal dissociating and rotating�signet ring� sign on x-rays.
SNAC wrist may often result in DISI
Rx: progressive DJD may lead to four-corner arthrodesis
Scapholunate advanced collapse (SLAC wrist): SLLdissociation with progressive intercarpal and radiocarpal DJD and volar or dorsal carpal displacement (DISI & VISI). Causes: trauma, CPPD, DJD, Kienboch disease (AVN of Lunate), Preiserdisease (AVN of Scaphoid).
SLL dissociation will lead to Dorsal or VolarIntercarlate aka Intercarpal Segmental Instability (DISIor VISI).
Rad Dx: Dx underlying cause. X-rays demonstrate dorsal or volar angulation of the Lunate with increased or decreased scapholunate angle on the lateral view. On frontal view: Terry Thomas sign or widening of scapholunate distance 3-4-mm as the upper limit of normal.
�MRI may help with ligament evaluation and pre-surgical planning
Rx: often operative with late DJD. Four-corner arthrodesis
Triquetrum Fx: 2nd m/c carpal bone Fx. M/C dorsal aspect is avulsed by the�tough Dorsal radiocarpal ligament. Cause: FOOSH.
Imaging: x-radiography wrist series is sufficient. Best revealed on the lateral view as an avulsed bone fragment adjacent to the dorsum of the Triquetrum. CT may help if radiographically equivocal.
Rx: conservative care
Complications: rare, may persist as pain on the dorsum of the wrist
Hook of the Hamate Fx: m/c occurs in batting sports (cricket, baseball, hockey, impact by a golf club, etc.) 2% of carpusFx.
Imaging: x-radiography may fail to detect an Fx unless “carpal tunnel view” is used. CT may help if x-rays unrewarding.
Clinically: pain, positive pull test, weak, painful grip. Deep ulnar n. Branch may be affected within the�Guyon canal.
Rx: usually non-operative, but chronic non-union may require excision.
DDx: bipartite hamate
�Lunate vs. Perilunate dislocation: Lunate is m/c dislocated carpal bone. Overall infrequent carpal injury. However, often missed!
Occurs with FOOSH and wrist extended and ulnar deviated. Imaging: 1st step x-rays. Ifunrewarding or require more complex injury evaluation CT scanning.
Key Rad DDx: DDx Lunate from perilunate dislocation. Lunate dislocation: lunate lost its contact with distal radius �spilled teacup� on the lateral. Perilunate dislocation: Lunate maintains its contact with distal radius despite the Capitatedorsally dislocated. Lunate dislocation is additionally helped to identify a �pie sign� d/t Lunate overlapping the Capitate
Rx: emergency reduction and operative repair of torn ligaments
Metacarpal & Phalangeal Injuries
Bennett Fx: intra-articular but noncomminuted impact-type Fx of the base of 1st MC bone of the thumb. X-radiography is sufficient.
Rad Dx: characteristic triangular fragment of bone on the ulnar aspect of the 1st MCbase, often with radial subluxation of the remaining radial aspect of the 1st MC
Complications: DJD, non-union, etc.
Rx: prone to instability/non-union requiring an operative care
Rolando Fx: aka comminuted Bennett with Y or T-configuration. More complex injury. It is unstable requiring operative care
Gamekeeper thumb: traditionally described as a chronic tear of the�ulnar (medial) collateral ligament at 1stMCP in English Gamekeepers’ who performed neck twisting/killing of small game. An acute injury may also be named as Skier’s thumb. This injury can be ligamentous w/o a fracture and an avulsion injury at the 1st proximal phalanx base.
Complication: Stener lesion or displacement of torn ligament over Adductor pollicis muscle that cannot heal w/o surgical repair. MRI Dx is required.
Avoid thumb stress views that can induce a Stenerlesion
Imaging: x-radiography followed by MRI to Dx Stenerlesion. MSK US can be used if MRI is unavailable.
�Stener lesion on MRI & MSUS: ulnar collateral stump is more superficial to Adductor pollicis aponeurosis and appears like a low signal mass-like stump forming so-called “yo-yo on the string sign” reported both on MRI and MSK US.
Rx: often operative
Boxer Fx: m/c MC Fx. An extra-articular usually non-comminuted or minimal comminuted Fx through m/c the 5th and sometimes the 4th MCneck-head junction (occasionally through the shaft) resulting in volar head angulation. Mechanism: direct impact as in clenched fist punching hard surface (e.g., facial bones/wall punching) hence 95% in young males.
Imaging: x-radiography hand series is sufficient
Rad Dx: Fx line transverse or oblique through MCneck with volar head angulation. Evaluate the degree of displacement, critical to report.
N.B. If the same mechanism fractures the 2ndand 3d MC in the same anatomic area, it may require operative care.
Phalangeal hand Fx: m/c skeleton Fx (10% of all Fx). Sports and industrial injuries dominate
Imaging: x-radiography with hand series or PA/lateral finger views will suffice
Rad Dx: if prox phalanx Fx, distal fragment is angled volarly with prox fragment dorsally. Distal phalanx may be angled dorsally. Key observation: nail bed injury, which considered an open Fx with a�risk of infection.
Rx: if <10-degree angulation-buddy-taping with motion rehab. CRPP vs. ORIF can be considered in complex cases-Orthopedic hand surgeon referral
Complication: loss of motion, necrosis, infection.May result with amputation
For additional common injuries: PIP is m/c dislocated joint. Mullet (Baseball) finger, Jersey finger and other injury refer to:
Felon: septic infection of the fingertip pulp typically with Staph.Aureus. Causes: needle prick(diabetics), paronychia, nail splinters, etc. m/c in index and thumb, presenting with pain, swelling, etc.
D/t specific pulp anatomy theinfection>swelling leads to pulp compartment syndrome-pressure and necrosis.
Rx: operative with incision distal to DIP, irrigation/debridement
Pediatric Wrist Injury
Incomplete Fx: Greenstick Fx, Torus (Buckle)Fx, Bowing (Plastic) deformity/Fx. D/t FOSHe.g. fell off the monkey bar. m/c affects <10-years-old.
Rx: usually non-operative (closed reduction and casting)
Distal Radioulnar Joint (DRUJ) Instability-common injury following trauma as in FOOSHwith wrist hyperextension and rotation and disruption of DRUJ ligaments and TFCcomplex. Avulsion of ulnar styloid with the�dorsal or volar displacement of distal ulnar should be noted.
Imaging steps: x-rays initially, MRI may identify ligaments and TFC damage, MSKUScan help with ligaments tearing.
Wrist DJD-typically is secondary to trauma, scapholunate dissociation, SLAC, SNAC wrist, CPPD, Keinboch or Preiser Disease and others.
May lead to major functional loss
Imaging: typically presents as radiocarpal JSL, subchondral sclerosis,osteophytosis, subcortical cysts, and loose bodies. Typically additional induces intercarpal degeneration and particularly Tri-scaphe joint.
MRI may be helpful with early recognition of scapholunate dissociation, Lunate/Navicular AVN.
If isolated MCP OA noted considerCPPD & Hemochromatosis (Hook-like osteophytes)
Typically painless except 1st CMC OA
DIPs-Heberden nodes, PIPs-Bouchard nodes
Erosive OA (occasionally called�inflammatory OA�)
A Spectrum of OA but producing central proximal erosions at DIPs and PIPsresulting with very characteristic �gullwing� appearance. No systemic inflammation (no CRP, RF, Anti-CCP Ab)typically in middle-aged/elderly females, like Hand OA, often seen in families
Rheumatoid Arthritis (RA)-chronic systemic inflammatory disease of unknown etiology, targeting synovial joints, tendons with multiple systemic involvement (lung, CVS, Ocular, Skin, etc.) Pathology: Tcell>Macrophage/APC>mediatedautoimmune process resulting in pannus formation and gradual destruction of ST, cartilage, bone,�and other tissues. 3% FemalesVS.1% Males. Environmental triggers: infection, trauma, smoking,�and others in a genetically susceptible individual. 20-30%may be disabled after 10-years.
Due to his significant craftsmanship in San Antonio, TX, Ottis Hamlet must largely rely on the use of his best tools: his hands. Unfortunately, Mr. Hamlet developed debilitating symptoms in both of his arms because of carpal tunnel syndrome, which dramatically impacted his capacity to participate in his occupation and therefore affecting his quality of life as a result. Ottis Hamlet was able to find relief for his hand and wrist pain with Dr. Alex Jimenez through a trip to El Paso, TX and he received chiropractic treatment for his carpal tunnel syndrome, preventing the need to undergo any surgical interventions.
Carpal Tunnel Chiropractic Treatment
Carpal tunnel syndrome is a medical condition resulting from the compression of the nerve that travels via the wrist and in the lymph nodes. Typical symptoms include pain, tingling sensations and numbness, at the thumb, index finger, middle finger, and the thumb side of this ring fingers. Symptoms normally begin gradually and may continue throughout the day. Symptoms may stretch throughout the arm and also diminished grip power may also happen. Carpal tunnel syndrome may be diagnosed according to its symptoms.
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Numbness in any portion of the hand or in specific fingers, followed by a tingling sensation and sharp pain traveling through the hands can occur as a result of various underlying conditions. Many people report symptoms suggesting the development of carpal tunnel syndrome but, although diagnosis might indicate the cause for the condition, sometimes a diagnosis could point to the incorrect root of the problem.
The median nerve and various other tendons travel from the forearm to the hand through a small indentation in the wrist known as the carpal tunnel. The role of the median nerve is to provide movement and feeling in the thumb and first three fingers, excluding the smallest finger in the hand. When an individual begins experiencing the associated symptoms of carpal tunnel syndrome, such as tingling, numbness, weakness, or pain in the fingers or hand, these could be the result to an impingement of the median nerve at the carpal tunnel, generally caused by irritation on the nerves of the wrist.
Thoracic Outlet Syndrome
Although many people could experience numbness in their fingers, the compression could be occurring at another region within the body. Regardless of the cause of your symptoms, if you�re experienced numbness in the hands and fingers, you should consider seeking chiropractic care.
Carpal tunnel syndrome is a condition caused by an impingement of the median nerve found at the wrist, usually causing symptoms of hand and finger numbness, tingling sensations, weakness, and pain. But, occasionally, the symptoms associated with carpal tunnel syndrome can be caused by complications to the spine, generally the cervical spine. For more information on the subject matter, please feel free to ask Dr. Jimenez or contact us at (915) 850-0900.
Carpal tunnel syndrome is a condition involving numerous symptoms affecting the hands and wrists. This painful condition is caused when the median nerve, found within the carpal tunnel of the wrist along with other tendons in the hand, becomes compressed.
The median nerve functions by controlling nerve sensations and impulses from the palm area of the fingers and the thumb as well as to the muscles in the hand, providing feeling and movement. When the tendons become irritated, causing inflammation and swelling, an impingement of the median nerve occurs, resulting in carpal tunnel syndrome. The pinched nerve may then develop a variety of symptoms most commonly associated to the condition.
Symptoms of Carpal Tunnel Syndrome
Trauma from an accident to the hand or wrist and/or overuse from repetitive activities, such as constant typing on a keyboard, are common reasons carpal tunnel syndrome develops. The added pressure begins to irritate and compress the median nerve, leading to the impairing symptoms of pain, among others.
The most common symptoms include pain, numbness, a tingling sensation, and weakness on the hands, wrists, and forearms. Pain and numbness in these areas is usually intense. The discomfort from these symptoms can affect an individual�s everyday lifestyles. Gripping objects may become difficult as carpal tunnel syndrome progresses over time due to loss of muscle strength. The tingling sensations radiating from the hand is often described as a feeling of �pins and needles� through the hands, wrists, and forearms.
By Dr. Alex Jimenez
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