Carpal Tunnel Syndrome
Carpal Tunnel Syndrome is a painful progressive condition of the wrist and hand and usually occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes compressed or squeezed at the wrist causing inflammation, pain and numbness in and around the region.
Carpal Tunnel Syndrome can also be caused when the median nerve is entrapped in other locations causing the muscles in the forearm to tighten, thereby cutting off circulation to the median nerve and tendons, causing the tendons to swell?
Anatomy of the Carpal Tunnel
The carpal tunnel is a narrow passageway located on the palm side of the wrist. It is comprised of eight carpal bones that form an arch creating three sides of the channel. A band of tissue, the transverse carpal ligament, covers this arch. This tunnel protects the median nerve, which is the main nerve to the hand and the nine tendons that bend the fingers and thumb.
‘The median nerve controls sensations to the palm side of the thumb and first three fingers (not the little finger) and impulses to some of the small muscles in the hand that enable movement in the fingers and thumb’. (Orthopedic and Sports Medicine Institute (OSMI))
Symptoms of Carpal Tunnel Syndrome
Carpal Tunnel Syndrome may begin with a gradual onset of numbness and tingling in the thumb, index, and middle fingers (but not the little finger). The numbness may come and go.
Some people experience pain in the arm between the hand and the elbow. The compression of the nerve into the wrist may cause weakness and muscle loss causing difficulty when carrying objects.
Causes of Carpal Tunnel Syndrome
The compression of the median nerve could be the result of one or a combination of many factors. Anything that causes swelling or makes the carpal tunnel smaller can cause pressure on the median nerve.
Trauma: An injury to the wrist
Physical Predisposition: A person whose carpal tunnel that is smaller than average leaving little room for the nerve and tendons.
Disease: Diseases such as hypothyroidism, rheumatoid arthritis, and diabetes can cause inflammation or fluid build-up.
Repetitive Motion: Activities that involve repetitive motion. Eg. computer mouse use all day
Hormonal Changes: Hormonal changes during pregnancy or menopause may cause fluid retention.
Growths: Infections, cysts, or tumors in the carpal tunnel impeding on the limited space.
Treatment of Carpal Tunnel Syndrome
I don’t understand the mystery around Carpal Tunnel Syndrome. If you have been able to operate your hand up to this stage in your life then what has changed? If your muscles are under stress and inflammation is occurring in the carpal tunnel then let’s address the reasons. Treatment for the problem is required.
Anti-inflammatory medication will assist in relieving symptoms and reducing inflammation in the tendons and relaxing muscles but that is not a long term solution.
‘A recent study conducted at The Touch Research Institute at the University of Miami School of Medicine looked at the efficacy of bodywork in treating carpal tunnel syndrome. Researchers found that after the completion of four massage sessions, the participants experienced an improvement in grip strength and a decrease in pain, anxiety, and depression. Participants also showed improvement in specific medical tests used to diagnose carpal tunnel syndrome’. (Massagetherapy.com)
Bodywork and Massage play a major role in the relief of Carpal Tunnel Syndrome. Massage promotes blood circulation, which in turn aids in reducing the inflammation and helps in removing the metabolic residues, soothing the irritated or painful muscles and tendons leading through the carpal tunnel.
Manual stretching of the ligaments in the forearm helps reduce inflammation of tendons (tendonitis) through the carpel tunnel that are crowding out the Median Nerve.
Massage, especially deep tissue techniques, neuromuscular therapy, Muscle Release Techniques can relax the connective tissue fibers, break up scar tissue, and reduce or eliminate the cause of inflammation. Massage can give a greater range of movement to the arm eliminating repetitive use of selected muscles. Soft tissue work helps realign these tiny fibers of the tendons and sheaths, easing or even eliminating Carpal Tunnel Syndrome.
The Bigger Picture
‘The symptoms of Carpal Tunnel Syndrome may reveal an even bigger problem. The nerves that carry sensory and motor information to the hand arise from the spinal cord in the neck, travel under the collar bone, through the armpit and elbow, all the way to the wrist. A nerve can become entrapped at the neck, shoulder, elbow, or wrist, and an impingement in any of these places can have a cumulative effect on the tingling felt in the hands. These entrapments are usually caused by poor postural habits. The soft tissues become shortened around habitual positions of rounded shoulders and forward head from working long hours at the computer and the channels where the nerves travel through the shoulders and arms can close down’. (Massagetherapy.com)
As a manual therapist who has treated Carpal Tunnel Syndrome I think it is imperative to massage and release all muscles from the neck through the shoulder to the elbow, releasing the strain on the forearm muscles. The forearm muscles and ligaments develop strongly and inflame, due to compensating for weaker connecting muscle, inhibiting the nerve as they squeeze through the carpal tunnel.
Other Non-Surgical Treatment
• Rest: Rest the affected hand/wrist and avoid activities that aggravate symptoms.
• Immobilization: A wrist splint can be used to hold the wrist in a straight position and prevent further damage. The splint is most important during sleep because many people curl up with bent wrists during sleep, which places added pressure on the median nerve. Many patients wear the splint throughout the day as well.
• Steroid Injections: A corticosteroid injection—more commonly known as a cortisone shot—is a powerful anti-inflammatory agent injected directly into the carpal tunnel. The shot can reduce inflammation and pain. Steroid injections for carpal tunnel syndrome are successful in about 20-50 percent of patients, but symptoms often return. (Sports Medicine Institute)
'Surgical treatment may be necessary if symptoms do not respond to non-surgical treatment after six months or if symptoms are severe and there is significant damage to the median nerve'. (Orthopedic and Sports Medicine Institute (OSMI))
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