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Nutritional Post-Surgical Management of CTS

Obviously, the goal of all health care providers, including chiropractic management of Carpal Tunnel Syndrome (CTS), is to AVOID surgical intervention, but this is not always possible. Last month, we looked at herbal approaches to reduce inflammation with the focused goal of preventing surgical need. But, as chiropractors, we also care for patients post CTS surgery, and one of our treatment approaches beyond manual therapies includes nutritional management (In addition to Active Release Techniques to address scar tissue in the forearm muscles).

As we all know, during the surgical process, tissue damage occurs due to incisions, removal of injured tissue, and other factors. Depending on the “success” of the surgical procedure, damage to the nerves causing numbness, weakness, and/or other nerve related symptoms can occur. Often, nerves will regenerate during the healing process but not always 100%. This may be due to factors such as the amount of tissue damaged during the surgery, the length of time CTS had been present pre-surgery, how well the patient follows post-surgical instructions, as well as the general health and overall condition of the patient. A healthy diet along with certain specific vitamins can play a positive role in tissue healing and nerve regeneration. Here are some examples:

  1. Folate or vitamin B9 has been reported to have beneficial effects on the genes located within the nerve cells that help to regulate the healing process. One study published in 2010 reported that folate helped to promote nerve repair in the central nervous system (CNS) in rats, which is unique as typically nerve damage in the CNS does not usually regenerate. Anti-inflammatory benefits have also been reported with vitamins B6, B9, and B12.
  2. Cobalamin or Vitamin B12 has also been reported to facilitate nerve regeneration after injury. This, along with the anti-inflammatory benefits, supports the use of B12 in the post-surgical CTS patient.
  3. Vitamin D may also play a significant role in nerve regeneration after surgery. In one study, vitamin D2 was found to have a positive effect on nerve regeneration. Another study reported that D3 and calcium together has strong anti-inflammatory benefits.
  4. Vitamin B6: There is evidence that supports the use of B6 both before and after surgery. Some feel B6 acts directly on nerve repair and others report a diuretic (fluid reducing) benefit. One cause and/or complication of CTS is fluid retention, which commonly occurs in conditions such as pregnancy, the use of birth control pills, obesity, diabetes, and others. Thus, keeping fluids in our tissues under control can certainly help CTS patients. Most studies agree that less than 200mg of B6 per day is safe. The dosage should be carefully monitored as numbness/tingling (a common CTS symptom) can be a sign of B6 toxicity.
  5. Vitamin C has long been reported to facilitate in the wound healing process. It also is an effective anti-inflammatory agent, a common problem in the cause of CTS as well as a negative post-surgical side effect. A dose of 1000-3000mg/day spread out throughout the day is beneficial to the post-surgical healing process.
  6. Vitamin E: As far back as 1967, Vitamin E been reported to reduce inflammation. More recent studies report that when used in combination with vitamin C, the two together works even better in reducing inflammation than either one alone. Also, this combination was found to improve the body’s ability to use insulin, which may also facilitate healing in the post-surgical CTS patient.

There are many others we didn’t get to (such as B1, 3, 5; zinc, Bromelain, and Quercetin). Bottom line: Eat healthy, exercise, don’t smoke, and fortify your diet with these nutrients!

We realize you have a choice in who you consider for your health care provision and we sincerely appreciate your trust in choosing the Active Release certified chiropractors at Denver Chiropractic Center for those needs.  If you, a friend or family member require care for CTS, we would be honored to render our services.

Fibromyalgia – Where Does the Pain Come From?

Fibromyalgia (FM) is a very strange condition. Can you think of any other condition that creates so many symptoms and yet all the blood and imaging tests are negative? FM symptoms include chronic fatigue, muscle aches and pains, depression, sleep disturbance, memory affects, and more. The degree or severity of FM varies from mild to severe, leaving some totally disabled and distraught. So, the question of the month is, where does the pain come from?

Since the usual markers of injury are negative (that is, blood and other tests), we can tell you first that the pain is NOT coming from damaged tissue such as muscle, bone, organs, and the like. If it did, abnormal enzymes &/or inflammatory tests would result. Rather, the origin of pain appears to be arising from within the central nervous system. That is to say, there are portions of the brain and spinal cord where pain signals are received and when they reach a certain level or threshold, the sensation is felt. When the sensory input is below that level, it will not be felt. In fact, there are MANY MORE incoming sensory signals that are NOT felt compared to those that are. This “thermostat-like” function is vital so we DO NOT feel everything that arrives to the brain. This is why we don’t feel the clothes hanging from our backs or the shoes on our feet (unless the laces are tied too tight!). It’s been said that if we DID “sense” all the incoming signals we would, in a sense, “…short circuit.”

In the FM patient, this thermostat is “messed up.” It is set lower than what is considered normal, and as a result, patients do sense or feel more than they should. This “nervous system overload,” sometimes referred to as a “sensory storm,” occurs in the FM sufferer. A more fancy term called “central sensitization” can be searched and you will find a LOT to read about this interesting subject (check it out)!

So how does this hypersensitive situation start? Fibromyalgia is classified into two main categories – type I and type II. In type I, or primary FM, the cause is unknown. The cause could include one’s genetic make-up, but the bottom line is, we really don’t know. In type II or, secondary FM, some other known condition or situation can be identified such as irritable bowel syndrome, rheumatoid arthritis, after a trauma, or following an illness or infection. Some also feel the lack of sleep or sleep loss can cause FM. This is because it takes about four hours of sustained sleep to reach deep sleep, and because of frequent sleep interruptions, the person never reaches deep sleep. Over time, deprived of the relaxing deep sleep benefits, the body gradually tightens up, “re-setting the thermostat” and too much sensory information reaches the brain, resulting in overload, and a heightened pain level is perceived. Studies have shown that when sleep is restored, many FM patients gradually improve and function better. This focus on sleep restoration is important in the management strategies of FM treatment. We all know our tolerance to just about everything suffers when we are over-tired, similar to the toddler who cries at the drop of a dime when they need a nap.

Chiropractic adjustments, certain nutrients like melatonin, valerian root, and vitamin B complex can facilitate sleep restoration. Treatment for sleep apnea can also help patients with FM. As we’ve said before, FM is usually multi-factorial and including chiropractic in the FM treatment “team” is essential for a satisfying result!

If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services!

“Harder than a Half-Ironman,” Dr. Glenn’s Race Report (pic), and the 1-Page Health News (w/video)

My friend and fellow Altitude Multisport club member Justin Chester summed up Xterra Beaver Creek perfectly, “That’s harder than a Half-Ironman!” I don’t know about that since I’ve never done a Half-Ironman. But I do know this: Beaver Creek, for such a posh place, serves up one tough off-road triathlon course. For the record, I did the Sprint version.

I’m never too focused to high-five my kids at the bike-run transition!

Overall, I had a good day. My swim was slower than last year, possibly related to my lack of swim training this year. I guess I shouldn’t have taken 7 months out the pool after last season? The bike and run were about the same as last year (maybe a tad slower). Overall I was only 4 minutes off of last year’s time. I’ll take it! Next up is Xterra Indian Peaks at Eldora ski resort this coming Saturday. That’s right, 2 Saturdays in a row.

Weekly Health Update
Week of: Monday, July 22th, 2013
“A healthy outside starts from the inside.”
~ Robert Urich

Mental Attitude: Obsessed With Forbidden Pleasures.
When individuals are forbidden from everyday objects, their minds and brains pay more attention to them. Obsession is not as strong if others are also denied. When an object is forbidden to a group, the allure of the object drops dramatically. This helps to explain why group diet programs can be more successful than dieting alone.
Cognitive, Affective and Behavioral Neuroscience, June 2013

Health Alert: Kids Poisoned.
Every 10 minutes a child in the United States is taken to the Emergency Room because of poisoning from swallowing a prescription or over-the-counter medicine. The most common drugs associated with children’s poisoning include those used to treat diabetes, high cholesterol (statins), pain (opioids), and cardiovascular diseases (beta blockers).
Pediatrics, June 2013

Diet: Soda, Illegal Drugs, and Teeth.
Drinking large quantities of soda can be as damaging to your teeth (tooth erosion) as methamphetamine and crack cocaine use. Tooth erosion occurs when acid wears away tooth enamel. Without enamel, teeth are more susceptible to developing cavities, as well as becoming sensitive, cracked, and discolored. The citric acid present in both regular and diet soda is known to have a high potential for causing tooth erosion. The ingredients used in preparing methamphetamine can include extremely corrosive materials such as battery acid, lantern fuel, and drain cleaner. Crack cocaine is also highly acidic in nature.
General Dentistry, June 2013

Exercise: Quantity Over Frequency?
A study of over 2,300 Canadian adults found that those who exercised 150 minutes over just a few days of the week received the same health benefits as those who spread out 150 minutes of exercise over the entire week.
Physiology, Nutrition, and Metabolism, June 2013

Chiropractic: Success!
A study compared the effectiveness of manual therapy (performed by a Chiropractor), physical therapy (performed by a Physical Therapist), and medical care (delivered by a Medical Physician) for patients with neck pain. The success rate at 7 weeks was twice as high for the chiropractic therapy group (68.3%) compared to the medical care group. Patients receiving chiropractic therapy had fewer absences from work than patients receiving physical therapy or medical care for their neck pain. Manual therapy and physical therapy also resulted in statistically significant less analgesic (pain relief medication) use.
Annals of Internal Medicine, 2002

Wellness/Prevention: Prevent Stress.
Among women who reported stress, 40% had psychosomatic symptoms in the form of aches and pain in their muscles and joints, 28% suffered from headaches or migraines, and 28% reported gastrointestinal complaints. (Note- I’m sure men would have reported even more complaints, as everyone knows women are the tougher gender.)
University of Gothenburg, June 2013

As always, thanks for reading,

Carpal Tunnel Syndrome – Nutritional Considerations

Carpal Tunnel Syndrome (CTS) is a condition where the median nerve that arises in the neck and travels through the shoulder, arm, and into the hand becomes compressed. Compression of the median nerve results in tingling, numbness, pain and/or weakness that affects the 2nd, 3rd, and thumb-side half of the 4th fingers. It can wake sufferers up in the middle of the night, forcing them to have to shake the hand and flick the fingers to “wake it up.” This can occur multiples times a night, making for a long next day! We’ve discussed chiropractic management strategies such as manipulation/mobilization of the neck, shoulder, elbow, wrist and hand, the use of a cock-up splint (especially at night and at times when driving), but more information regarding the use of nutritional supplementation is lacking; hence the purpose of this Health Update!

 

Let’s look at what we are trying to accomplish by nutritional approaches for CTS:

  1. Anti-inflammation: Because of stomach, liver, and kidney side effects, NSAIDs such as ibuprofen, aspirin, and others may not be your best choice. Rather, consider Turmeric (300 mcg), Ginger (100 mg), Boswellia (100 mg), Rosemary (100 mg), Bioflavonoid (100 mg), Bromelain (50 mg), Vitamin C (1-3 grams/day), Vitamin E (400 IU/day), Vitamin D3 (2000-5000 IU/day), Vitamin B-complex (especially B6, 9, and 12).
  2. Muscle relaxation: Calcium (1500mg/day), Magnesium (400 mg/day), Potassium, valerian root (vervain), B-Complex, L-Arginine, Rosemary, Catnip, Kava root, Chamomile, Cayenne Pepper, Horseradish, Lavender, Licorice, Devil’s Claw.
  3. Nerve repair: Folate (B9), B12 (cobalamin), Vitamin D3, B1 (Thiamin; minimum: 1.2mg/day), B5 (Pantothenic acid), B3 (niacin; minimum 16 mg/day), B12.
  4. Managing systemic conditions:

a)      Diabetes (dysinsulinism): Chromium (picolinate or choloride), Alpha-Lipoic Acid, Omega-3 Fatty Acids (1000 mg of EPA & DHA), Coenzyme Q10, Polyphenols (dark chocolate, green tea), Botanicals (plant extracts such as garlic, prickly pear, aloe vera, fenugreek, bitter melon and ginseng).

b)     Thyroid dysfunction (hypothyroid): B-Complex (100 mg of B1, 3, 5, & 6 3x/day; B2, 50 mg 2x/day; B12 1000-2000 mcg/day; Selenium and iodine, Anti-oxidants (Selenium, Vit. C, Vit. E) Copper, thyroid extract, organic iodine.

c)      Obesity (BMI>30): Childhood obesity: Vit. D (ages 1-13, 5 mcg/day), B12, Vit. C, Fiber, Calcium (an extra 300mg of Calcium= >2 lb. weight drop); other fat soluble vitamins (Vit. A, E, and K), iron (iron is more commonly deficient in obese children and adults and can lead to fatigue and poor mental health and memory function).

  1. Other considerations: General health: paleo diet, sleep quality, and exercise (see below).

 

You may notice that there is a lot of overlap in many of these vitamin recommendations. If one were to give nutritional recommendations for general health purposes, the anti-inflammatory “big 5” might include 1. A good quality multi-vitamin mineral, 2. Magnesium (often with calcium as a combined supplement), 3. Omega-3 fatty acids; 4. Vitamin D; and 5. Coenzyme Q10. For CTS specifically, the addition of a B complex seems consistently recommended above.  Controlling weight will reduce CTS risk and decrease the risk of acquiring type II diabetes which increases CTS risk by itself. Perhaps an “ideal diet” for everyone might include eating plenty of fruits, vegetables, lean meats, and the elimination of gluten (grains) – referred to by some as the “anti-inflammatory diet,” paleo diet, caveman diet, and Mediterranean diet. Fortifying a great diet with vitamins is the “take-home” concept!

Common Questions about Cervical Disk Herniations

Last month, we discussed the topic of neck pain arising from cervical disk herniations. The focus of this month’s Health Update is common questions that arise from patients suffering from cervical disk derangement.

1. “What can I do to help myself for my herniated disk in my neck?” The mnemonic device “PRICE” stands for Protect, Rest, Ice Compress, and Elevate is a good tool to use in the acute stage of many musculoskeletal conditions.

  • Protect your health by NOT placing yourself in an environment that is likely to harm you, such as playing sports or doing heavy yard work. That is, think about what you do BEFORE you do it and if sharp, radiating pain occurs, STOP and assess the importance of what you are doing. Use the concept, “…don’t pick at your cut.” This means if you want the injury to heal, don’t keep irritating it!
  • Rest is similar. Limit your activities to those that can be done without increasing symptoms, especially radiating pain.
  • Ice – The use of ice reduces swelling/inflammation, which reduces pain and promotes healing. Alternate it every 15-20 minutes (on/off/on/off/on) several times a day. You can also use contrast therapy (Ice/heat/ice/heat/ice) at 10/5/10/5/10 minute intervals to “pump” out the swelling.
  • Compress – The use of a collar worn backwards, if it’s more comfortable that way, can literally “take the load off.” the neck and disks. There are even inflatable collars which are pumped up with air to traction the neck. Other forms of traction will be discussed further.
  • Elevate – The concept of raising the ankle to the height of the heart so swelling can drain out of the ankle is the classic example of “elevation.” In the neck, the traction concept may apply once again.

2. “I don’t want to have surgery if I can help it. What can you do as a chiropractor to help me?” This is one of our primary goals, and in fact, the goal of ALL health care providers, even surgeons! Chiropractic offers anti-inflammatory measures: ice, herbal anti-inflammatory agents (ginger, turmeric, bioflavonoid, curcumin, bromelain, Rosemary extract, Boswellia Extract, and more), digestive enzymes taken between meals, muscle relaxant nutrients (valerian root, vitamin D, a B complex, chamomile, magnesium, and others) as well as other non-pharmaceutical options. Treatments consist of manual manipulation, mobilization, traction (for home and office), modalities such as laser and low-level laser, electrical stimulation, magnetic field, ultrasound, and others.

Most important is having a “coach” guide you through the stages of healing by first addressing the acute inflammatory stage (first 72 hrs), the proliferative or reparative phase (up to 6-8 weeks), followed by the remodeling phase (8 weeks to 1 or 2 years) and finally, the contraction phase (lifetime – includes the natural shortening of scar tissue). If manual traction reduces neck and arm pain, the use of home traction is very effective. Options include sitting over-the-door traction, laying down versions, and mobile traction collars (discussed previously).

Exercises to stretch and strengthen the neck are also very important in reducing neck pain as well as preventing recurrences. If in spite of all the best efforts of this non-surgical care approach should ongoing neurological loss and relentless symptoms continue, we will coordinate care with physiatrists for possible injection therapy and pharmaceuticals, with neurology for further testing (such as EMG/NCV – a nerve test), and/or neuro- or orthopedic surgery – THE LAST RESORT!

We realize that you have a choice in where you receive your healthcare services.  If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future. 303.300.0424 [email protected]

 

Video- if you can’t do this, you may have a problem, your odds needing back surgery, and this week’s 1-Page Health News

Hi Glenn,

Happy Monday! Well, the heat is back. And for most of us active people, that’s kind of a good thing. Maybe I’m odd, but I enjoy riding my bike on a really hot day.

There’s an interesting study from the journal Spine showing that back pain patients who started with a chiropractor were 28 times less likely to end up having surgery than patients who started by seeing a surgeon. (see below).

This week, Dr. Stripling has a great video for you on the chair squat. I know, you’re thinking, “The squat again?” Here’s the truth: there are a few basic movements that add up over time. If you can’t get yourself closer to the ground correctly, you wear out your spine. Then, one day, you go to tie a shoe, or pick up a bag of dog food, or sneeze – and blow your back out. We see it day in and day out in our office. So, after reading this week’s 1-Page Health News, I strongly suggest taking a look at this week’s video. Of course, if you have a bad back already, you should learn this under our supervision (call us). Proceed wisely!

Health Alert: What Concussion?
Many United States high school football players think it’s okay to play with a concussion even though they know they are at risk of serious injury. Over 90% of players polled recognized a risk of serious injury if they returned to play too quickly, but only 54% would always or sometimes report their concussion symptoms to their coach. Pediatric Academic Society, May 2013

Diet: Fight Inflammation!
Chronic inflammation is a condition that can be triggered by obesity and can ultimately lead to both cardiovascular and metabolic disease. Some foods that are known to combat unhealthy inflammation are citrus fruits, leafy greens, tomatoes, wild salmon, and whole foods high in fiber. University of Alabama at Birmingham, March 2013

Exercise: ‘Walkable’ Neighborhoods.
Preschool children are less likely to be obese if they live in a neighborhood that is safe and within walking distance of parks and retail services. Pediatric Academic Society, May 2013

Chiropractic: I Like Those Odds!
Patients who went to a chiropractor first had were less likely to undergo surgery than those who went to a surgeon first. 42.7% of workers with back injuries who first saw a surgeon had surgery, in contrast to only 1.5% of those who initially saw a chiropractor.  Spine, December 2012

Wellness/Prevention: Brain Power Boost.
Regularly consuming the healthy fats found in fish, extra virgin olive oil, and nuts may assist in maintaining cognitive functions in older individuals. British Medical.
Journal, May 2013.
Video link: Dr. Stripling shows you the chair squat. You really should be able to do this pain free.

Awesome Dog finds a great home:

I’m happy to report that Rooster has found a home. My good friend Dave Kupernick adopted Rooster from my other good friend Andrew Stone. Most of you know that Mr. Stone is the canine behaviorist who trained our 1-year old chocolate lab when she was a pup. If have a dog that has behavioral problems, I strongly recommend you have Mr. Stone help you get your dog “reprogrammed” and behaving in a more civilized manner. Call Andrew Stone directly at 720-366-2238

Denver Chiropractic Center Weekly Health Update

“If you want others to be happy, practice compassion.
If you want to be happy, practice compassion”
~ Unknown

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Mental Attitude: The Elderly and Facebook.
Elderly adults who learned to use Facebook on a daily basis scored 25% better on tests measuring their cognitive abilities than their peers who did not.
University of Arizona, February 2013

Health Alert: Baby Boomers Vs. Preceding Generation!
As each generation grows older, they believe they are healthier than the previous generation. However, the baby boomers are unable to make this claim. Compared to the preceding generation at the same stage of their lives, fewer have “excellent” health (13% vs. 32%), more have high blood pressure (75% vs. 35%), and more are obese (36% vs. 25%).
JAMA Internal Medicine, February 2013

Diet: The Southern Diet and Stroke.
People from the American South are 20% more likely to have a stroke than those from other parts of the country, and the Southern diet may be to blame. People who eat Southern style food high in fat, sugar, and salt at least 6 times a week were at 41% higher risk for a stoke. People whose diets consisted of fruits, vegetables, and whole grains at least 5 times a week were 29% less likely to have a stroke.
American Stroke Association, February 2013

Exercise: Tai Chi?

Tai Chi may reduce falls among adult stroke survivors. Tai Chi is a martial art dating back to ancient China that includes physical movements, mental concentration, and relaxed breathing.
American Stroke Association, February 2013

Chiropractic: Recommended For Back Pain.
The Royal College of General Practitoners’ 2009 recommendation for treating non-specific low back pain advises doctors to advocate exercise and manipulation (such as chiropractic care) before pharmacological (drug) therapies and more invasive treatments (like surgery).
National Institute for Health and Clinical Excellences, 2009

Wellness/Prevention: Sunshine and Rheumatoid Arthritis.
Routine exposure to the sun, especially ultraviolet B (UVB) rays, may decrease the risk of rheumatoid arthritis. Those with the most elevated rates of exposure were 21% less likely to develop rheumatoid arthritis than who had less exposure.
Annals of the Rheumatic Diseases, February 2013

Who replaced Miss Keri, Denver Chiropractic Center shows you how to help your own ankle sprain, and the one-page health news.

This week we welcome our new office manager Natalie who is taking the reins from Keri. We look forward to working with Natalie for a long time. This week, as we’re all digging out from the snow, we have another video from Dr. Stripling. He’s covering ankle sprains. We treat lots of ankle sprains at Denver Chiropractic Center. As scar tissue affects the injured ankle, it’s left stiff and painful. By using Active Release Techniques to break up the scar tissue, and using some appropriate re-training techniques, we can usually dramatically shorten the time it takes for sprained ankles to heal.

 

Mental Attitude: No Interruptions Please. Short interruptions (such as the few seconds it takes to silence that buzzing smart phone) have a surprisingly large effect on one’s ability to accurately complete a task. Interruptions of just three seconds can double your chances for making errors. Journal of Experimental Psychology: General, January 2013

Health Alert: American Health. Americans have shorter life expectancy and higher rates of injury and disease than citizens of other industrialized countries. A 2011 report showed that the US ranked 50th in life expectancy. In most health issues (infant mortality, teenage pregnancies, sexually transmitted diseases, heart disease, chronic lung disease, disability, obesity, diabetes, drug-related deaths, homicides, injuries, and HIV/AIDS), the US is either at the bottom or near the bottom of the list of industrialized nations. Institute of Medicine and the National Research Council, January 2013

Exercise: Not At School! In the 1920s, 97% of US college students were required to take Physical Education (PE); today, that number is at an all-time low of 39%. 34% of adolescents and teens ages 12-19 are overweight and 17% are obese. These rates have roughly doubled since 1980. The median PE budget for schools in the US is $764 per school year in K-12 and 61% of PE teachers report an annual budget of less than $1,000. Obesity will cost the US $344 billion in medical- related expenses by 2018, about 21% of the nation’s total health-care spending. Research Quarterly for Exercise and Sport, January 2013

Chiropractic: Inflammation! Inflammation is your body’s natural response to injury and is part of the healing process. However, if proper care is not received, inflammation can hinder the healing process and may lead to scarring, improper motion, and additional pain. Signs of inflammation include: pain, heat, redness, swelling, and loss of function. Chiropractic adjustments and care can reduce inflammation and pain naturally!

Quote: “A healthy attitude is contagious but don’t wait to catch it from others. Be a carrier.” ~ Tom Stoppard

Video: Dr. Stripling’s Ankle sprain video can be found on our blog by clicking here.

Carpal Tunnel Syndrome – Are There Other Tunnels?, by the Active Release certified doctors at Denver Chiropractic Center

Carpal Tunnel Syndrome – Are There Other Tunnels?

Carpal Tunnel Syndrome (CTS) refers to the median nerve being pinched in a tunnel at the wrist. As the name implies, “carpal” refers to the 8 small bones in the wrist that make up the “U” shaped part of the tunnel and “syndrome” means symptoms that are specific and unique to this condition. As we learned last month, CTS can be affected by nerve pinches more proximal to the wrist, such as at the forearm, elbow, mid-upper arm, shoulder or neck.

To make matters more complex, there are two other nerves in the arm that can also be pinched in different tunnels, and the symptoms of numbing and tingling in the arm and hand occur with those conditions as well. This is why a careful clinical history, examination, and sometimes special tests like an EMG/NCV (electromyogram/nerve conduction velocity) offer the information that allows for an accurate diagnosis of one or more of these “tunnel syndromes” in the “CTS” patient. Let’s look at these different tunnels and their associated symptoms, as this will help you understand the ways we can differentiate between these various syndromes or conditions.

Let’s start at the neck. There are seven cervical vertebrae and eight cervical spinal nerves that exit the spine through a small hole called the IVF (intervertebral foramen). Each nerve, like a wire to a light, goes specifically to a known location which includes: the head (nerves C1, 2, 3), the neck and shoulders (C4, 5), the thumb side of the arm (C6), the middle hand and finger (C7) and the pinky side of the lower arm and hand (C8). If a nerve gets pinched at the spinal level (such as a herniated disk in the neck), usually there is numbness, tingling, and/or pain and sometimes, usually a little later, weakness in the affected part/s of the arm and hand (or numbness in the scalp if it’s a C1-3 nerve pinch).

So, we can test the patient’s sensation using light touch, pin prick, vibration, and/or 2-points brought progressively closer together until 1-point is perceived and then comparing it to the other arm/hand. Reflexes and muscle strength are also tested to see if the motor part of the nerve is involved in the pinch. The exam includes compression tests of the neck to see if the arm “lights up” with symptoms during the test.

Next is the shoulder. Here, the nerves and blood vessels travel through an opening between the collar bone, 1st rib and the chest muscles (Pectorals). As you might think, the nerves and blood vessels can be stretched and pinched as they travel through this opening and can cause “thoracic outlet syndrome.” Symptoms occur when we raise the arm overhead.

Hence, our tests include checking the pulse at the wrist to see if it reduces or lessens in intensity as we raise the arm over the head. At the shoulder, the ulnar nerve is the most commonly pinched nerve, which will make the pinky side of the arm and hand numb, tingly, and/or painful. A less common place to pinch the nerves is along humerus bone (upper arm) by a bony process and ligament that is usually not there or resulting from a fracture. Here, an x-ray will show the problem.

The elbow is the MOST common place to trap the ulnar nerve in the “cubital tunnel” located at the inner elbow near the “funny bone” which we have all bumped more than once. Cubital tunnel syndrome affects the pinky side of the hand from the elbow down. The median/carpal tunnel nerve can get trapped here by the pronator teres muscle, thus “pronator tunnel syndrome.” This COMMONLY accompanies CTS and MUST be treated to obtain good results with CTS patients. The radial nerve can be trapped at the radial tunnel located on the outside of the elbow and creates thumb side and back of the hand numbness/tingling.

Any or all of these nerve can get “trapped” by the muscles that run near them. This is where Active Release Techniques (ART) treatment separates itself for other modalities. ART is the only system that trains providers how to check these entrapment spots muscle by muscle. Once identified, the trained and certified ART provider knows how to release the muscles and remove the pressure. This goes way beyond standard chiropractic treatment or basic physical therapy.

So now you see the importance of evaluating and treating ALL the tunnels when CTS is present so a thorough job is done (which is what we do at Denver Chiropractic Center). Try the LEAST invasive approach first – non-surgical treatment – as it’s usually all that is needed!

Dr. Jeff Stripling from Denver Chiropractic Center demonstrates a hip flexor stretch for Office workers, crossfitters, and everyone in between