Carpal Tunnel Syndrome

Hi everyone,

This blog is going to continue with a theme about technology (as we discussed some Apps for Appetite in the previous blog).  However, besides using technology to help our health, I want discusses a condition that can be caused by the use of technology because our western culture is very tech savvy and everyone uses computers.

Because of the change in social and work use of technology the prevalence of a Carpal Tunnel Syndrome has increased.  Keep in mind the use of computers isn’t the only thing that can cause carpal tunnel syndrome.  It can be caused by repetitive use of the wrist leading to a series of events that ultimately over time can cause carpal tunnel syndrome.  Besides occupational factors leading to carpal tunnel syndrome, carpal tunnel syndrome is associated with several diseases and situations. Some of these are:

  • arthritis
  • diabetes
  • gout
  • amyloidosis (infiltration of the liver, kidneys, spleen with a starch-like substance)
  • hypothyroidism (underactive thyroid gland)
  • tumours of tendon sheaths
  • wrist fractures and dislocations
  • wrist cysts
  • pregnancy
  • use of oral contraceptives
  • menopause

So What is the Carpal Tunnel?

The Carpal Tunnel is a structure created by the bones and ligaments of the wrist. There two bones in the forearm.  These two bones run parallel and form a U-shaped cup at our wrist. Inside this cup sit the eight tiny bones, called carpal or wrist bones.

ImageImage

These bones form what is known as the “floor” or the bottom of the Carpal Tunnel.  The “roof” of is a ligament. Between the roof and the floor, there are tendons going to the fingers (that control hand movement) and one nerve.  Basically, the carpal tunnel is a space where some tendons and a nerve go through.

So what? What is the big deal?

How does carpal tunnel syndrome develop?

Bending the wrist or moving the fingers moves the tendons that are in the carpal tunnel.  The tendons are encased in sheaths. These sheaths allow the tendons to slide.  The walls of the sheaths contain a fluid to keep the tendons moving smoothly.  With repetitive or excessive movement of the hand and/or wrist, the lubrication of the tendons in the sheath decreases.   This ultimately leads to friction between the tendon and its sheath causing inflammation and swelling.  The swelling then leads to squeezing of the nerve in the carpal tunnel. Repeated episodes of inflammation cause fibrous tissue to form, again putting pressure on the median nerve.  In non-occupational causes of carpal tunnel syndrome, there is still an increase in the volume of the contents of the carpal tunnel, resulting in compression of the nerve.

The symptoms of nerve compression can result in sensations of numbness, tingling, pain, and clumsiness of the hand. This combination of symptoms is called carpal tunnel syndrome. If left alone long enough a severe case can lead to weakness and eventually atrophy of groups of muscles in the hand.

Numbness and Pain

Numbness and Pain with Carpal Tunnel Syndrome

Muscle Wasting

Muscle Wasting with Carpal Tunnel Syndrome

Here is a good video visually showing the carpal tunnel.   http://www.youtube.com/watch?v=J11EIfiHMYw

Treatment options for Carpal Tunnel Syndrome

Traditional medical treatment options for carpal tunnel syndrome include such things as pain medications, cortisone shots and even surgery.  Since carpal tunnel is due to ligament enlargement and compression, and chiropractors specialize in treating joints/ligaments, consider visiting a chiropractor in your local area.  Chiropractors can offer treatment options such as joint mobilization(Chiropractic Adjustments), Acupuncture, Graston Technique®, Kinesiotaping, exercises and even ergonomic advice to help treat this condition.

I offer a great therapy in the office, called the Graston Technique® to treat carpal tunnel syndrome.  Here is a video demonstrating the treatment.

http://www.youtube.com/watch?v=pUYKIS3Ty8A

http://www.grastontechnique.com/file/sites|*|86|*|EDGE-Archives|*|DCs|*|Summary-of-Graston-Technique-Carpal-Tunnel-Syndrome-Research-Project.pdf

Anyways, I hope that explains how technology can be both helpful and harmful.

Thanks,

Dr. Reena

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Appetite for Apps

Yesterday, July 8, 2013,  Apple was celebrating the fifth anniversary of its app store by offering some of its most popular games and apps for free.   The limited time offerings include: Barefoot World Atlas, Day One, How to Cook Everything, Over, Traktor DJ, Badland, Infinity Blade II, Superbrothers: Sword & Sworcery, Tiny Wings and Where’s My Water?  These apps may remain free for a short time to celebrate.

The buzz around the apps for free got me thinking about apps for smartphones (whether they be iPhones, Androids, Windows Phones, or even Blackberry Phones).  Apps are used nowadays for everything from GPS to tracking a person’s run, to even calorie counting to name a few.  But what good apps are out there for the health-conscious?

Here are some of my favourite apps:

Fooducate

Fooducate

      1.   Fooducate  is an app that is available for iPhone and Android.  It automatically grades foods and beverages on a scale from A to D. (10 distinct grades: A, A-, B+, B, B-, C+, C, C-, D+, and D). It actively allows you to use your phone to scan barcodes that are on food and food products.  It then processes this information and gives you a rating of the food.  The food is ranked using an algorithm according to the nutrients it contains, the ingredients, the processing and fortification of the food.  While the database isn’t always complete, you are able to send and request information to be added to the database.   I know many people dislike having multiple usernames and passwords for the vast number of services annd applications that are available.  This app is functional without creating a username and password.  You can browse their databases for food to see how it ranks as well.  Some advantages of creating an account is that it keeps track of the foods you scan and you can personalize it, track your health and create shopping lists.   For those who are following an allergy-free or gluten-free diet, there is also a new app that came out in May of 2013 to use for that purpose.

MyFitnessPal

MyFitnessPal

 2.      MyFitness Pal is a free app (you can use it from their website as well) that is available on iPhone, Blackberry,  Windows Phone and  Android platforms.  It is a way of tracking your physical activity and overall calorie intake.  Additionally, based on your height and weight and weight-loss goals, it tells you how many calories you should be taking to maintain a certain weight or to reach a goal weight   It allows you to enter food you eat, and using their database, estimate the calories per serving and also input your physical activity (which is converted to calories burned and taken away from your general calorie intake) to determine your net caloric intake.  You do require a username and an active e-mail address to use this app. Alternatively, you can link it to your Facebook account.  Their online database includes ways to calculate calories from recipes based on serving sizes.  Once you have done this, you have the opportunity to add it to your food diary.  There is also a quick way to calculate your BMR.  Additionally, if you love social networking or working out and dieting with friends it allows you to connect socially with your friends (via the app) and monitor progress and obtain accountability.  

Buycott App

Buycott

3.      BuyCott is a nice app.  You need to have an user account or have it linked to your Facebook account to be functional.   It allows you to buy from brands that support causes that you care about.  Additionally, it lets you see where the money you spend is going and to make sure it is not going to go to fund causes you oppose.  Buycott is basically a tool that lets you organize your consumer spending to help causes that you care for, and to oppose those that you don’t. According to Buycott, it “basically can be used to scan a barcode with the Buycott app and it will look it up in their database and try to determine who owns it. Buycott will then trace the product’s ownership back to its top parent company and cross-check this company against the campaigns that you’ve joined before telling you whether it found a conflict.”  For me, I find it to be a helpful guide to finding food products that are not genetically modified.  This is simply done in the app by adding non-GMO foods as a campaign.(When you are in the app, there are campaigns you can read about and join).   The general population is becoming more aware of the controversy surrounding GMO foods and their prevalence in our food system; that is where the app comes in for me.   Forbes reviewed of the BuyCott app.

Non-GMO Food Guide

Non-GMO Project Shopping Guide

 4.     Non GMO Project Shopping Guide is another app that is available in the AppStore for Apple.  I was unable to verify if it was available on any other platform.  For those who are interested but unable to get the app, you can use the resources at The Non-GMO Project, a not-for-profit organization committed educating consumers and providing verified non-GMO food choices.  While it isn’t a complete database, it is a great start.  I believe that knowing what’s in your food is a basic right.  I like the way things are heading in the European Union with the right to know if their food contains GMOs, the same goes for all Chinese, Russian, and Saudi Arabian consumers.  

That’s all for now.  I will be occasionally updating this blog with apps that I find useful.   If anyone out there has any suggestions for apps, please feel free to comment on the blog.

Thanks,

Dr Reena

King’s Body Found in Parking Lot & Scoliosis

Hi again, everyone!

I want to put different/interesting/entertaining spin on this blog while still being helpful about  Chiropractic, Acupuncture and services that are offered at my office.

King’s Body Found in Parking Lot & Scoliosis

I recently read an article on CNN about the bony remains of King Richard III being found in a parking lot in England hundreds of years after his violent death (killed in battle on The Fields of Bosworth in 1485 see:http://www.cnn.com/2013/05/24/world/europe/richard-iii-burial).

For centuries, poor Rick had the dubious honour of being the last British Monarch to be killed in battle. He was hastily buried in a Church grave which was too small for his body. The Church was eventually built over and became a modern day parking structure. For centuries, history –thanks largely to William Shakespeare – has portrayed King Richard III as a notoriously evil and hunchbacked villain (who allegedly killed his nephews, “the Princes in the Tower” to gain the throne). While some may debate his character, archaeologists and scientists were able to examine the slain King’s bones and were able to verify that he did have a “hunchback” which in chiropractic terms, means he suffered from scoliosis, a condition which results in an abnormal and painful curvature of the spine.

According to Live Science, treatment for scoliosis in the medieval times of King Richard III was akin to torture (ie. tying rope under armpits and around legs, then pulling either end to stretch the spine). Thankfully today, King Richard – and anyone suffering from scoliosis- would undergo more humane and less painful treatment.

See, the poor King suffered from what’s called “structural scoliosis” meaning his “hunchback” arose from a bony defect that he had since birth which then caused his spine to grow abnormally. This is different than functional scoliosis in which the muscles surrounding the spine actually cause it to deform. In other words, a person cannot be born with functional scoliosis. This condition is more easily treated with orthotics (to correct differences in the length of a person’s legs), ultrasound, TENS, Acupuncture and the Graston Technique.

If King Richard came to my chiropractic office, well before he wound up on the Fields of Bosworth, I would have been able to diagnosis his scoliosis with a simple exam and possibly had him fitted with a rigid brace (if he was still growing).   The worst that would have happened is that he’d have required some diagnostic imaging and a possible surgery. If you or your loved ones have questions about back pain or are looking for relief from it, give my office a call

For those that want to be more technical, please continue to read below about Scoliosis.

What is a scoliosis?

Scoliosis is an abnormal curvature of the spine. The spine bends/leans to one side of the body, causing the torso to compress on that side that it is bent towards.  The ribs on that side will be closer together while the ribs of the other side will be farther apart. Scoliosis also may involve a rotation of the spine, in which the individual vertebrae bones twist around the long axis of the spine.  The scoliosis can occur in any region of the spine.  The image below, shows scoliosis in various regions of the spine.

Curved Spine

Curved Spine

A scoliosis can be can be classfied as non-structural (functional) and structural.  King Richard III had a structural scoliosis.

Non-Structural or Functional Scoliosis

A non-structural or functional scoliosis occurs when a structurally normal spine appears curved. This is usually caused by such things as a difference in leg length, muscle spasms (sprains/strains/postural compensation), or inflammatory conditions such as a kidney infection or even appendicitis.  Chiropractors can treat this type of scoliosis by correcting the underlying problem.

In terms of a functional scoliosis caused by leg length discrepancy, it can be corrected with lower extremity support, such as orthotics.  Orthotics in this type of treatment usually used to correct for a low medial arch and excessive pronation in order to functionally correct the issues with foot mechanics,.  For some patients they may also require a heel lift.

If the scoliosis is caused by a muscular imbalance or spasm, generally chiropractic treatments may use soft tissue techniques to release the spasm and correct the imbalance with rehabilitation exercises.   One such treatment is the Graston Technique. But other treatments such as ultrasound, TENS, Interferential Current and even Acupuncture may be used.

Structural Scoliosis

A structural scoliosis is fixed (abnormal) curve that is in in the spine.  Each case is treated on an individual basis as it depends on the severity of the curve present.

Some causes of a structural scoliosis could be inherited connective tissue disorders (such as Ehlers-Danlos syndrome, or even Marfan’s Syndrome) or even neuromuscular diseases (cerebral palsy, muscular dystrophy), birth defects, injury, certain infections and tumours.

In the case of structural scoliosis, they are usually caught at an early age by a doctor during a physical exam, or previously, I have heard of school scoliosis screening programs.  Usually this program will detect mild scoliosis that generally do do not need treatment.  If a larger scoliosis is detected, usually x-ray images and possibly MRI/CT images may be taken if there is neurological/organ involvement.   The treatment will depend on the age of each patient, how much more he or she is likely to grow (if growth plates are still open), the degree and pattern of the curve, and the type  and location of scoliosis (what area of the spine). Treatment options may include simple observation, bracing and surgery.

Generally, if the scoliosis is mild, the patient is allowed to be observed without any treatment.  The chiropractic doctor and/or doctor/radiologist  follow patient’s growth and monitor the changes of the spine.  Re-examinations are performed at regular intervals to monitor if treatment is required.

If the scoliosis is mild to moderate, bracing is another treatment option.  A rigid brace is custom made and worn by a patient to stop a curve from getting any worse while the patient is still growing. Again, this patient would be monitored over time, to see how growth occurs to correct the scoliosis.

In severe cases of scoliosis, surgery may be a treatment that is recommended.  This is done to correct a curve or stop it from worsening when the patient is still growing.

For more reading on scoliosis: http://www.chiro.org/research/ABSTRACTS/Scoliosis.shtml