What is Carpal Tunnel Syndrome?
Carpal Tunnel Syndrome (CTS) is a prevalent and often debilitating condition that affects millions of people worldwide. It occurs when the median nerve, which runs from the forearm into the hand, becomes compressed at the wrist within the carpal tunnel. The Carpal tunnel is formed by the small bones of the hand and a thick transverse ligament that acts as a dome and overlies these small bones of the hand. Early and accurate diagnosis is crucial for effective management and treatment. CTS is the most common nerve entrapment referred for electrodiagnostic testing by a neurologist or neurologist technician.
Unfortunately, a CTS diagnosis is sometimes assigned too hastily, without sufficient evidence to support it. CTS shares symptoms with various other conditions and these symptoms can often be attributed to different factors like muscle strain or general hand fatigue. As a result, making a definitive CTS diagnosis based solely on clinical assessments can lead to misdiagnosis. This inaccuracy leads to poor treatment outcomes with continued suffering by the person unnecessarily carrying a false label. Many patients who present in the clinic with a carpal tunnel diagnosis may in fact respond very well to neck and thoracic manipulative strategies. These patients generally present with C6-C7 nerve root issues in the neck which tend to be very responsive to Chiropractic Treatment Sydney and rehabilitation.
So how can you be sure that the rationale used for YOUR diagnosis is adequate or accurate?
If cervical (neck) MRI imaging comes back clear and there is no abnormality on ultrasound of the wrist and hand, then electrodiagnostic studies are invaluable to bring about a legitimate diagnosis. In recent years, the use of electrodiagnostic studies with advanced nerve conduction equipment has greatly enhanced the precision of CTS diagnosis, allowing for more targeted therapies and better outcomes for Sydney Chiropractic Centre patients.
There are a few conditions that can mimic CTS so that treatment can be effective. In order to provide a clear pathway for treatment, imaging studies and blood work is pivotal. Some of these conditions include:
1. Repetitive stress
2. Hypothyroidism
3. Diabetes
4. Connective tissue diseases including rheumatoid arthritis
5. Tumours within the carpal tunnel
6. Congenital disorders such as smaller carpal tunnel space,tendon and artery anomlies.
7. Trauma such as hemorrhage from anticoagulant medications
8. Infectious and inflammatory conditions such as tenosynovitis and septic arthritis
9. Spasticity of the hand
10. Pregnancy or any condition that increases total body fluid
Understanding Carpal Tunnel Syndrome
CTS typically presents with symptoms such as tingling, numbness, pain and weakness in the hand and fingers. These symptoms can be triggered or exacerbated by repetitive hand movements, such as typing or gripping. While a thorough clinical assessment in a Sydney Chiropractic Centre invaluable in diagnosing CTS, electrodiagnostic studies have become a cornerstone in providing a definitive diagnosis and assessing the severity of the condition.
Some of the clues that indicate you may have carpal tunnel syndrome include:
1. Abnormal sensations for at least 4 weeks involving at least two digits of digits 1 – 4
2. Intermittent symptoms, or, if constant, were previously intermittent
3. May have accompanying pain but NOT pain alone
4. Symptom aggregation through Sleep, sustained hand or arm posturing or repetitive hand actions
5. Symptoms improve by change in hand position, shaking hands out or use of wrist splints
6. If pain is present, it involves the hand and fingers far greater than the arm, forearm or neck
The Role of Electrodiagnostic Studies
Electrodiagnostic studies involve the use of electrical measurements to evaluate the functioning of nerves and muscles. These studies can provide critical information about the severity, location and type of nerve that is compressed (sensory or motor) in CTS. Two primary tests used in the diagnosis of CTS are nerve conduction studies (NCS) and electromyography (EMG).
The factors considered using electrodiagnostic studies in the diagnosis of CTS include:
1. Localising median nerve abnormalities to the carpal tunnel
2. Exclusion of alternative diagnoses of CTS
3. Diagnosing superimposed disorder(s) contributing to symptoms that may cause ongoing symptoms after treatment of CTS, such as cervical nerve root compression, brachial plexopathy or peripheral neuropathy
4. Defining the severity of the neurogenic injury
5. Baseline quantitative data before surgery
What exactly are these studies and what do they show?
Nerve Conduction Studies (NCS):
NCS measures how quickly electrical signals travel through the nerves. In CTS, the median nerve’s conduction is often impaired due to compression within the carpal tunnel. Our specialised equipment allows for accurate measurement of the nerve’s conduction velocity and amplitude. Slower conduction and reduced amplitude are indicative of nerve damage, helping to confirm the diagnosis. It is important to note however, that the median nerve can also be compressed at the elbow, forearm muscles and even at the neck. Applying appropriate routine Electrodiagnostics can safeguard a patient from having an unnecessary carpal tunnel release surgery.
Electromyography (EMG):
EMG assesses the electrical activity of muscles. In severe CTS, muscle weakness and muscle electromyographic changes can develop due to nerve compression. Being able to measure the electrical activity in the affected muscles, identifying abnormal patterns associated with CTS can greatly assist in understanding the severity of muscle involvement and can guide treatment decisions.
There are a range of Nerve Conduction Study techniques that we can perform in practice to determine the type, location and severity of focal nerve compression in relation to the CTS. We use an algorithmic approach adopted from The American Association of Neuromuscular and Electrodiagnostic Medicine:
The above images represent a combination of carpal tunnel studies that can determine the severity and location of median nerve entrapment within the carpal tunnel space. Secondly, Our Sydney Best Chiropractor is able to determine if the sensory or motor portion of the nerve is affected. This will greatly alter the prognosis of recovery. Finally, some of these studies involve comparing the median nerve (the nerve that affected in CTS) with 2 other nerves in the hand to provide us with a prognosis with much greater sensitivity and accuracy.
What are the Benefits of Electrodiagnostic Studies in diagnosis of CTS?
1. Precision: Our testing can provide highly accurate and reliable data, reducing the chance of misdiagnosis and ensuring that you receive the appropriate treatment.
2. Objective Assessment: Unlike clinical evaluations, which can be subjective, electrodiagnostic studies offer objective data that can be tracked over time, aiding in monitoring progression of the condition and treatment effectiveness.
3. Customised Treatment: A more accurate diagnosis allows us to tailor treatment plans to your specific needs.
4. Better Understanding: Precise diagnosis empowers you with a clear understanding of your condition, its severity and the recommended treatments. Being better informed means you can engage actively in your care, knowing that you are doing so with the utmost confidence.
The accurate diagnosis of Carpal Tunnel Syndrome is crucial for effective management and improved outcomes. Electrodiagnostic studies, particularly when performed using advanced equipment, play a pivotal role in achieving this accuracy. These studies provide objective data on nerve and muscle function, helping us make informed decisions about your treatment progress.
If you know someone who has been labelled with a diagnosis of carpal tunnel syndrome or suspects they may have signs of it but they are unsure how to proceed with an accurate diagnosis and treatment plan, please direct them to contact our clinic!
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https://the-chiro-hub.cliniko.com/bookings#service