Carpal Tunnel Syndrome

Carpal tunnel syndrome

What is it?
Compression of the median nerve in the carpal tunnel. The floor of the tunnel is formed by the carpal bones (just below the wrist crease) and the roof is formed by a dense fibrous band called the transverse carpal ligament. The median nerve and 9 tendons pass through the tunnel on their way to the hand and fingers.

Symptoms
Numbness, tingling and pain in the thumb, index and middle fingers. Symptoms are often worse at night if the wrists are in a bent position which decreases the amount of room in the carpal tunnel. Splints that keep the wrists straight are often prescribed.

Causes
Compression of the nerve generally occurs if the size of the tunnel decreases or the size of the contents increase. 

A decrease in the size of the tunnel happens when:

• a bony callus develops after a fracture of a carpal bone or the end of the radius
• there are lesions such as ganglia, lipomas or cysts
• bony changes have occurred owing to rheumatoid arthritis.

The size of the contents of the tunnel can increase with:

• repetitive actions of the wrist and hands such as chopping, cleaning and typing, leading to inflammation or adhesion between the tendons and their sheaths thereby increasing the size of the tendon sheath.
• thickening of the roof of the tunnel owing to scar tissue from repeated trauma.
• conditions such as diabetes, hypothyroidism, rheumatoid arthritis and pregnancy which can cause swelling, fluid retention or connective tissue degeneration.

Misdiagnoses

Median nerve entrapment is one of the most common upper extremity injuries. There are at least half a dozen sites between the neck and hand where the nerve can trap. This explains why traditional carpal tunnel treatments aren't always successful. The nerve may not be trapping in the carpal tunnel or it may be trapping there and at other sites as well, such as the thoracic outlet or between the two heads of the pronator teres muscle in the forearm.

Treatment

Traditional approaches:

• Work place ergonomics - wrist braces and supports, altered work schedules to mix activities etc. 
• reduction of offending activities (if you can work out what they are!)
• corticosteroid injections, anti-inflammatory drugs, diurectics if the cause is fluid retention.
• Night splints
• Surgery - an incision is made in the transverse carpal ligament to relieve the pressure

Massage therapy

A massage therapist can treat the entire path of the median nerve (not directly on the nerve) to make sure that any potential entrapment sites are completely released. This will involve soft tissue techniques on the neck, shoulder, chest, arm, forearm and hand. Relieving the tension from the muscles and other tissue helps to take the strain off the tendons in the tunnel. It will also address circulation which may be a contributory factor. Rather than purely focusing on the tunnel an holistic approach can be taken which is often much more effective; long lasting and addresses the cause of the entrapment. Self help techniques can then be given: self massage, stretching and strengthening which are an essential part of rehabilitation.

If you would like to book an appointment or just have a chat about this please phone me on 07894 630450.