Carpal Tunnel Syndrome
Most of us have heard the name of carpal tunnel syndrome, but not many know what it is. I'll give you an explanation, and then tell you about the current treatments usually prescribed. After all, the more information you have, the better a decision you can make as to how you want to go about eliminating it.
The carpal tunnel is essentially an archway made of bone. When your palm is face-up to the ceiling, then the bony arch is upside down, with the "top" of the arch toward the back of your wrist. Across the "bottom" open end of the arch, a thickened band of connective tissue (called the flexor retinaculum) crosses to close off the arch and create a "tunnel." This tunnel is of the pathway for many of the tendons of the forearm flexor muscles (which control hand movement and grip) as they descend from their respective muscles in the forearm down into the fingers and palm. Along with the tendons, the median nerve crosses the wrist through the carpal tunnel. The median nerve innervates (or supplies nerve function to) some of the muscle at the base of the thumb (area of the thenar eminence) as well as some small muscles that are used for movement of the first two fingers. It also innervates the skin on the palm side of the thumb, index, middle, and ring fingers.
So now that you know what structures are involved, what happens? In carpal tunnel syndrome, the soft tissue that are within the carpal tunnel get inflamed and thickened. Usually this occurs due to trauma or overuse, such as typing on a computer at work for years. The muscles of the forearm continue to shorten and thicken the more they are overused, which causes them to get inflamed. As this cycle continues (more shortening, thickening, and inflammation), it propagates further down the muscles and causes their tendons to get inflamed. As the tendons get inflamed, they use up more room within the carpal tunnel (which is limited on space anyhow). As more room is used up by the inflamed tendons, more friction is created and thus there is more inflammation. As this process continues, the median nerve starts to get compressed and irritated. As the nerve gets trapped and inflamed, you experience numbness or pain or both.
Conventional treatment for carpal tunnel syndrome tends to be one of the following:
- Wrist splints - Immobilization at the wrist does ease some pressure on the tendons by preventing the tendons from becoming either over stretched or over contracted. Typically this is the "wait and see" approach to see if the swelling/inflammation will go down on its own (or with the assistance of drugs). This is ineffective since it does not do anything to soften up and lengthen the irritated muscles and tendons which are the source of the problem.
- Surgery - Usually the flexor retinaculum (the connective tissue thickening that keeps the tendons and the median nerve in the carpal tunnel) is either cut completely, or cut such that it expands like an accordion. The idea here is to create some additional space so that pressure is taken off the nerve, and general inflammation can decrease. Carpal tunnel surgery has mixed results, often with recurrence of symptoms in a reasonably short period of time. Again, the source of the problem (the thickened inflamed muscles and tendons) have not been addressed. This may account for the recurrence of symptoms, but it is also a strong possibility that the whole situation has been misdiagnosed... read on!
- Manual therapy - Proper massage therapy or manual therapy will address the issue at the source by softening and lengthening the forearm muscles and fascia, working down from the elbow and forearm into the wrist and hand. As these structures soften and lengthen, the inflammation is able to recede, and with it the pain and numbness go away. This is by far the most effective, cost-efficient, and non-invasive way to deal with carpal tunnel syndrome.
Unfortunately, many people are misdiagnosed with carpal tunnel syndrome when they actually have thoracic outlet syndrome! Thoracic outlet syndrome is a similar case of nerve entrapment with symptoms of numbness, tingling, or pain in the forearm, wrist, or hand, but the nerve is trapped higher up in the system (at the neck and/or shoulder). Make sure that whoever you seek treatment from is aware of both conditions and has the ability to diagnose and treat both.
In addition to which ever treatment protocol you choose, you should also be aware that the majority of cases in both carpal tunnel syndrome and thoracic outlet syndrome are caused by:
- Poor posture or positioning
- A combination of both of the above.
Because our behavior, posture, and positioning of our bodies are usually the cause of both carpal tunnel syndrome and thoracic outlet syndrome, it only makes sence to modify our behaviors to prevent future issues. Your therapist or doctor should be able to give you some helpful suggestions in this regard.