Carpal tunnel syndrome (CTS) is the most commonly diagnosed disabling condition of the upper extremities (your arms). CTS can very dramatically decrease your quality of life, interfering with sleep, productivity at work, focus, and takes the enjoyment out of leisure activities. This condition has such a chronic nature it can have a negative impact on your mood as well. People with CTS suffer from chronic numbness and/or tingling in the hands, loss of grip strength and dexterity, discomfort in the forearms, difficulty finding a comfortable sleeping position due to numbness and tingling, and they often have head and neck complaints.
“True” carpal tunnel syndrome is defined as compression of the median nerve in the carpal tunnel. The carpal tunnel is your wrist. The bones of the wrist and the flexor retinaculum create the walls of this tunnel. Within that you have 10 tendons, synovial sheaths, and the median nerve. Chronic compression of the median nerve is what creates carpal tunnel syndrome. Nerves are responsible for sensations such as pain, light touch, vibration and proprioception. They need good circulation. In this way, they are just like blood vessels; if you compress them, blood cannot circulate. Your limb falls asleep and turns blue. If you compress a nerve, it has a really hard time transmitting neurological information. This can result in pain, numbness, weakness, tingling, etc. In order to restore neurological flow, the compression has to be removed.
Since we are talking about carpal tunnel syndrome, it should be obvious: the compression is happening at the wrist. Yes, this is usually a part of the compression, but most times the compression is not solely coming from the wrist. You can have compression from several places along the neck and arm all creating and compounding the compression. You can also have inflammation of the tissues that creates the actual compression within the wrist.
More often than not, people with carpal tunnel type symptoms are not just having compression of the median nerve. There are 5 main nerves that stem from the brachial plexus; (1) Axillary, (2) Musculocutaneous, (3) Median, (4) Ulnar, and (5) Radial. These nerves start in the neck, branch through your arms and some continue to the fingers.
The median nerve is the only nerve that passes through the carpal tunnel, but the other four nerves can also contribute to these types of symptoms in the shoulder and arm. Technically, this diagnosis becomes nerve entrapment and not just carpal tunnel. With true carpal tunnel the symptoms involve the tips of the first three and half fingers as, well as the corresponding palmar side of the hand. You can see the nerve sensory distributions in the picture below. (1)
According to American Family Physician the most common cause of carpal tunnel syndrome is repetitive maneuvers. (2) This includes fine motor activities like typing, handy work (hammering, use of screw drivers), etc.
Self-care and Prevention:
If you work one of these jobs, some practices to help prevent nerve entrapment syndromes are as follows:
Self-massage. We recommend using a medium to hard ball, tennis or lacrosse ball, to massage the muscles of your hands, arms and shoulders.
Regular stretching of the forearms and shoulders.
Exercises to counteract a forward rolled posture. Meaning, strengthening of your back musculature and core. If you don’t know where to start in the gym, we highly recommend find a physical therapist or personal trainer to help show you some great exercises.
As with any inflammatory process, we have to remove the irritant. With any sort of repetitive injury, rest is indicated in the acute phases. This may even require time off from work. If rest is not possible, Rocktape or Kinesiotape can help with circulation, neuro-muscular retraining and pain. Braces can also be helpful at work to help keep your wrist in a better ergonomic position. Supplementation with strong anti-inflammatory compounds like turmeric help to dampen inflammation internally and act as an analgesic. However, neither of these options are a cure.
Over time, with repetitive type injuries and inflammation you start to develop fibrosis in the tissues that creates friction. To restore the tissues back to health, they need treatment in conjunction with self-care. In our office we often use Chiropractic manipulation, dry needling, Graston or Gua Sha, myofascial release, cupping, and postural retraining exercises. All of these therapies help to restore the tissues and fascia and remove the friction through the different phases of healing. Deep tissue massage, Rolfing and the like are other great therapies to restore your tissues.
In cases where acute trauma was involved, like fracture of the wrist that changed the bony structure, or arthritic bony changes like osteophyte formation, conservative treatment may not be able to do the trick. In these cases surgery might be the best option. Regardless, it is still a good idea to give conservative therapy a shot. Chances are it can greatly improve your symptoms.