While Carpal tunnel syndrome is often treated successfully with surgery, a recent study shows high success with manual care without the risks or high costs of surgery.

Carpal tunnel syndrome (CTS) occurs when a tunnel shaped set of bones and cartilage in the wrist, which the median nerve and other tendons pass through, squeezes the median nerve as it passes from the forearm into the hand. Symptoms tend to build gradually. You might feel an itching numbness in the palm of the hand and the fingers, especially the thumb, index, and middle fingers. You might wake up at night with the feeling that you need to “shake out” the hand or wrist. It may progress to tingling in the hand, or a sharp pain that shoots from the wrist up your arm. Grip strength decreases making it hard to hold small objects or do manual tasks.1

The cause is often something of a mystery. Some think it is mainly a congenital problem where some people just are born with a smaller tunnel than others. But trauma to the wrist that causes swelling may contribute, as could arthritis or a cyst or tumor in the canal. Repeated use of vibrating hand tools may aggravate it and certain occupations are at high risk, including assembly line work like manufacturing, sewing, and meat, poultry, or fish packing. In comparison a 2001 study by the Mayo clinic found no increased risk from heavy computer use (up to 7 hours a day).2 Of course you may develop symptoms while using your computer, but risk for assemblers is three times that of data entry personnel. Women, perhaps because they have smaller bones than men, have three times the risk of men.3

In the recent study using manual therapy, patients with mild to moderate CTS were divided into two groups. Both received soft tissue mobilization, but in one group it was done by hand, strictly manually, while in the second group it was done with small hand tools (called the Graston Technique). Both methods can be done by chiropractic doctors and this study was designed to see which was better. The patients were seen 10 times over 6 weeks. In both groups objective measures showed range of motion and grip strength returned within normal limits similar to the patient’s other (unaffected) hand. The severity of their symptoms decreased and their ability to function improved in both groups.4
Relief of symptoms and return to function directly affect patient satisfaction with their care and accordingly the satisfaction ratings were very high. None of the patients were “very dissatisfied” or “dissatisfied”. In the Graston group all the patients, 100%, were either “satisfied” or “very satisfied” both at the end of the care period and at 3 month follow-up. In the strictly manual group 90 percent were satisfied or very satisfied, at the end of care. Ten percent felt “neutral”. After 3 months, 20 percent felt neutral but still 80 percent were satisfied (or very satisfied) with their results.5 While the Graston group appeared in the raw numbers to do slightly better, the study group was too small for that difference to be considered statistically significant. Future larger studies may show that it is.

In comparison surgery leads to relief of symptoms 75 to 99% of the time according to prior research referenced in this study which is similar to the 80 to 100% that were satisfied (or very satisfied) after 3 months in this study. However surgery results in complications in 1 to 2 patients out of a hundred and of these up to 12% may need a second surgery.6 The only complication of the manual care in this study was temporary bruising on the forearm.

The researchers concluded, “Manual therapies for CTS were effective at improving objective measures of impairments and patient-centered measures of symptom severity and functional abilities.”7
Our take on this is that if you suffer with CTS you would do well to try chiropractic care first. Surgery is still an option if you are dissatisfied but in this study none of the patients were. This is in keeping with the American Academy of Neurology that already recommends conservative management of CTS prior to surgical intervention.8

1.National Institute of Neurological Disorders and Stroke, National Institutes of Health, webpage http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm.
2. Ibid.
3. Ibid.
4. J. Burke, et al., “A Pilot Study Comparing Two Manual Therapy Interventions for Carpal Tunnel Syndrome,” January 2007, Journal of Manipulative & Physiological Therapeutics, Vol. 30, No. 1, p. 59.
5. Ibid., Table 5, p. 58.
6. Ibid., pp. 50-51.
7. Ibid., pp. 58-59.
8. Ibid., p. 50.

Once again we find that prescription drugs and even over the counter drugs can have unforeseen bad side effects.

Not long ago we found that the popular pain drug Vioxx raised your risk of dying from a heart attack. Now a new study shows that the very popular drugs that suppress acid in the stomach, called proton pump inhibitors (PPIs) dramatically raise risk of hip fracture. Researchers found that one year or more of PPI use was associated with a 44% increase in risk of hip fractures in those over 50 years old and the risk increased with both dosage and duration of use.1 This was a very large study of over 135,000 control subjects and over 13,000 hip fracture cases.

Some 95 million prescriptions of these PPIs were written in the United States in 2005 and include names like Nexium, Prevacid or Losec. But Americans also spent $1.9 million on Prilosec, an over the counter PPI.2 These are often used to prevent or treat heartburn or gastric reflux by reducing stomach acid but they are also widely used to prevent or treat stomach ulcers and bleeding that is often caused by long term use of non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Advil, Motrin, and others), aspirin, or Aleve.

People with chronic low back pain or other chronic pain conditions often use NSAIDs regularly, which have this not so nice side effect of causing stomach or intestinal bleeding and so they are often prescribed a PPI to help prevent that. Now we find those PPI’s have their own not so nice side effects. The researchers suggested that the PPIs might interfere with the normal absorption of calcium leading to weaker bones, but so far do not really know the mechanism that weakens the hip. They suggested using the lowest dose of PPIs possible.3 The study also found that another class of acid fighters called H2 blockers had a similar but smaller risk of hip fracture. These include Tagamet and Pepcid.4

Here is our take on this. If you have chronic pain, like low back pain, instead of using pain pills and then PPIs to counter their side effects, why not try chiropractic care to relieve your low back pain. Chiropractic usually relieves back pain without using any drugs so you don’t need to worry about side effects whether known or unknown. Pain medications only cover up the pain whereas chiropractic seeks to relieve the cause of the pain. Many chronic pain conditions respond to chiropractic care, so just say no to drugs and try chiropractic care instead.

1. Y. Yang, et al., “Long-term Proton Pump Inhibitor Therapy and Risk of Hip Fracture,” 2006, JAMA, Vol. 296, pp. 2947-53 (as reported by “Common Heartburn Medications May Raise the Risk of Hip Fracture,” January 2007, The Back Letter, Lippincott Williams & Wilkins, Hagerstown, MD, Vol. 22. No. 1, p. 2).
2. “Common Heartburn Medications May Raise the Risk of Hip Fracture,” January 2007, The Back Letter, Lippincott Williams & Wilkins, Hagerstown, MD, Vol. 22. No. 1, p. 2
3. Y. Yang, Op. Cit.
4. Associated Press, December 27, 2006, “Popular Heartburn Drugs Linked to Hip Fractures,” http://www.rep-am.com/story.php?id=17283