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Thu, Jul 24, 2014

DR. KESTNER: Unusual case of carpal tunnel syndrome

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Not long ago a patient came to see me about pain and tingling in her hand.

The wrist hurt and she felt a tingling pain into the middle of her palm toward the fingers.

As I examined her, I found that the symptoms were aggravated by certain positions of her wrist. It appeared that she had a case of carpal tunnel syndrome.

As I continued her examination, she also complained of frequent neck pain. I positioned her head so that she looked upward toward the ceiling, then slowly turned to the side and leaned a little further back. The tingling in her hand worsened as I had her turn her head.

Further examination located profound tenderness in the tendons and muscles around her elbow. Pressure in the elbow area even seemed to aggravate the wrist and hand.

I ordered an MRI and found that she had disc bulging in the neck at the level of the spine that would affect the nerves to her middle fingers.

What would explain this lady’s perplexing findings of having symptoms that were aggravated by maneuvers that stressed her cervical spine as well as her wrists?

In most cases, if a patient has a pinched nerve caused by a bulging disk in the neck, the wrists have no effect on the symptoms.

In most cases when a patient has carpal tunnel syndrome, the position of the neck has no effect on the symptoms. Yet this lady’s tingling increased whenever her neck or her wrist were maneuvered into stressed positions.

She was unfortunate enough to have a condition known as “double-crush” syndrome.

This is an unusual presentation in which a patient has nerve impingement at two locations along the path of a nerve, in this case the cervical spine and the wrist.

Often with double crush problems, there must be pressure in both areas to cause the symptoms. Or in this case, the pressure in either area was enough to cause symptoms.

For her to recover, both problem areas must be treated simultaneously. The pressure has to be relieved at the wrist as well as the neck.

Surgery may be required in severe cases of either cervical spine impingement or carpal tunnel impingement. However, resolving the problem without resorting to surgery is greatly preferred for numerous reasons.

To resolve the disc bulge in the neck, several options might be considered. Traditional chiropractic or physical therapy may be effective.

A greater likelihood of success lies in non-surgical spinal disc decompression (SDD), which is a conservative approach that targets the affected spinal disc by separating the vertebrae above and below it to take pressure off the disc.

The wrist problem is often related to the presence of tendinitis in the elbow and forearm. As the tendinitis progresses, the tissues become hypertrophic or enlarged and the nerve is compressed at the point of the narrowest passage in the wrist.

In many cases carpal tunnel syndrome or CTS can be resolved by conservative means. Manipulation of the affected wrist joint to improve function and relieve compression as well as treatment to the swollen tendons can resolve many cases without surgery. This is a great advantage in that it avoids the weakness that often follows surgery and eliminates scars and possible complications.

The patient will also undergo physical rehab training to stretch the affected structures and increase flexibility and strength.

It is always best to seek help for painful or neurological symptoms earlier rather than later. As a problem progresses, conservative options may be less helpful and surgery may be more likely.
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Dr. Kestner
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Health, Health Care, Living Well, Mark Kestner, Voices
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