Carpal Tunnel Syndrome

Disclaimer: While the information on this web site has been helpful to many people, you should check with your medical doctor or other health care professional in deciding what is the best course of action to take for your situation. This information is designed to help you be a better partner in your care, and not as a do-it-yourself guide to diagnosing and/or treating your health care issue.

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is a condition in which the median nerve is compressed in the carpal tunnel that it runs through in the front of the wrist. The median nerve transmits sensations from the hand to the brain. It also controls muscle activity on the thumb side of the hand. When the median nerve is compressed, there may be tingling or numbness in the thumb side of the hand. There may also be weakness and/or lack of coordination in the actions of the thumb and adjacent fingers.

What Causes Carpal Tunnel Syndrome?

The median nerve can become compressed in the carpal tunnel by thickening of the tendons of the muscles that share the tunnel space with the nerve. This thickening can be caused by tendonitis and/or by overuse of the muscles (often by excessive keyboarding or use of industrial equipment) combined with lack of stretching. Carpal tunnel syndrome can also be caused by an increase in the fluid content of the body in pregnancy as well as in some medical conditions.

You should see your doctor if you think you have carpal tunnel syndrome for a medical diagnosis and possible treatment.

Symptom Patterns in Carpal Tunnel Syndrome

Carpal tunnel syndrome can give a person weakness in their grip (especially affecting the thumb), numbness and tingling as well as pain. Each person may experience carpal tunnel syndrome a little differently. The chart at the side shows the idea that symptoms can be a pure experience of numbness, pain or weakness. Alternatively, there may be a mixture of symptoms.

It is important to have a good sense of what the symptoms are, so that you can evaluate whether you are getting better, staying the same, or getting worse.

Testing in Carpal Tunnel Syndrome

There are common physical tests for carpal tunnel syndrome. In Phalen’s test the person pushes their two hands together with their palms facing downward. If this creates the uncomfortable sensation (or worsens the discomfort already there) then you may have CTS. Some people have to hold the position for a second or two only, while others need to hold the position for 30 seconds to create discomfort. The more easily this test creates symptoms, then the more irritable the condition.

There are other physical tests that can be used to measure the sensitivity of the median nerve in the carpal tunnel as well as all along its course from the neck to the hand. These tests can be used to guide hands-on treatment as well as measure treatment success.

Click here for a YouTube video of Phalen’s testing in a case of carpal tunnel syndrome!

Medical evaluation for carpal tunnel syndrome may involve Nerve Conduction testing and/or Ultrasound evaluation. In Nerve Conduction testing an instrument is used to evaluate whether the nerve is still conducting electricity properly. In ultrasound assessment the size of the median nerve, tendons inside the carpal tunnel, the roof of the tunnel and the tunnel itself can be measured. Sometimes an x-ray will reveal bony abnormalities in the tunnel such as an abnormal bone and/or arthritis.

Some people opt for surgery immediately, but many people (including many surgeons) attempt to deal with the problem non-surgically and only proceed with surgery if the symptoms are becoming progressively worse with conservative care. The information on this page is to help people with conservative care.

Many different hands on practitioners may be helpful ranging from physiotherapists, chiropractors, osteopaths and massage therapists. Since I am a massage therapist, my self care suggestions are shaped by my training and my experiences with clients.

Hands on Treatment for Carpal Tunnel Syndrome

Hands therapy for carpal tunnel syndrome depends on locating the most significant locations that the median nerve is compromised. The following is a list of common locations that the median nerve can be compressed:

1. In the neck, the roots of the median nerve can be compressed by the spine

2. Under the clavicle: It is common for upper extremity nerves to be compressed between the clavicle and the underlying first rib.

3. Under the pectoralis minor muscle. This muscle is often short in people with forward-rounded shoulders.

4. Under the prontator teres muscle in the forearm. The pronator teres muscle is responsible for twisting type motions of the forearm and wrist. It is often tight in people who use their hands for manual labor.

5. Under the flexor retinaculum. Finally, the median nerve can be compressed in the palm side of the wrist.

Compression in any one location makes the nerve more vulnerable to compression everywhere else along its course. This has been termed the “double crush” phenomenon. Effective therapy usually includes decompressing the nerve at multiple sites along its course!

The image below illustrates fluid pumping designed to lessen congestion in the carpal tunnel.

The image below shows hands on techniques to release the flexor retinaculum.

Self Care for Carpal Tunnel Syndrome

There are often many factors that all add up to creating symptoms in the median nerve in the hand. The chart below outlines some of the common factors that contribute to carpal tunnel symptoms.

For more information on Self Care for Carpal Tunnel Syndrome go to our companion web site

Questions, comments, suggestions?     Contact Doug Alexander by clicking here.

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