CARPAL TUNNEL SYNDROME Getting a helping hand

Sometimes wearing a wrist brace is the worst thing you can do.
By WILLIAM K. ALCORN
VINDICATOR HEALTH WRITER
BOARDMAN -- That pain, numbness, tingling and burning sensation in your hands ... the weakness or loss of grip ... may not be carpal tunnel syndrome, a local chiropractor says.
If the pressure on the median nerve caused by irritation or inflammation of the tendons is not triggered by the carpal tunnel, then it is something else that requires a different treatment, says Phil Gainan, a chiropractor licensed in physical therapy.
The carpal tunnel is a round area in the wrist just on the hand side of the watchband area, formed by the carpal bones of the wrist on the bottom and the transverse carpal ligament on the top.
Gainan believes many of the cases that are diagnosed as carpal tunnel may instead be caused by muscle strength imbalance in the forearm. The imbalance produces lactic acid, a waste product, that can inflame the median nerve and cause CTS-like symptoms, he said.
Gainan said the whole premise of his treatment for carpal tunnel syndrome, if it is not true CTS, is to equalize the strength of the extensors, muscles on top of the forearm which get used less and are not as strong, with the muscles on the bottom of the arm, the flexors, which through repetitive work grow stronger and shorter.
When the extensors, or inhibitors, are not as strong as the flexors, the imbalance causes the release of lactic acid.
Treatment
If the problem is true CTS, sometimes a chiropractor can manipulate the bones to relieve the pinching of the nerve, Gainan said.
Gainan says he uses ultra sound waves to get molecules moving and break up adhesions and inflammation. His treatment also includes muscle stripping, stretching of flexors and strengthening extensors with specific exercises.
"If you don't build strength in the weak areas, injuries or pain will re-occur if you continue the same activity that caused them in the first place," he said.
The goal, Gainan said, is for patients to be able to continue exercises at home that will keep the problem from re-occurring.
"I consider myself successful if a patient doesn't have to keep coming back," he said.
"Sometimes wearing a wrist brace is the worst thing you can do, because when you don't move it, the range of motion of the wrist decreases, and adhesions in the joint or joint capsule can increase causing more pain," Gainan said.
Carpal tunnel syndrome is a stress injury often associated with people who work in jobs that involve highly repetitive use of the hands, such as meat packers, assembly line workers, cashiers, builders and people who spend a lot of time typing or at the computer keyboard.
Diagnosis
One way to diagnose carpal tunnel is the method of injury.
"If the patient fell and injured his wrist, it is probably carpal tunnel. What a patient does for a living or a hobby can also weigh in the diagnosis, as well as which activities make it better or worse," he said.
There are two phases to treatment -- relieve the pain and build strength so it does not return, Gainan said.
Gainan, 44, grew up in Boardman and graduated from high school here in 1978. He received a bachelor of science degree in business from Youngstown State University in 1984, before moving to California, where he graduated from the Los Angeles Chiropractic College at Whittier, Calif.
He moved back to Boardman in 1998 for family reasons and started the practice at its current location.
Gainan's wife, Shari, a registered nurse and message therapist, also works in the business. They have a son, Zack, age 3.
"It's real exciting. We've had some patients who had surgery without success that we've been able to help.
"I'm sure the doctor was good and the surgery was skillful. But, my contention is it might have been the wrong diagnosis," Gainan said. "I get a charge out of being able to help people, especially when they haven't had success before."
alcorn@vindy.com