Carpal Tunnel Syndrome

Carpal Tunnel Syndrome
February 5, 2012 No Comments - Arms and Hands,Injury Prevention,Managing Common Conditions,Rehabilitation,Repetitive Strain Injury Brian Fulton

A Light at The End of The Carpal Tunnel

Carpal Tunnel Syndrome (CTS) results in the highest number of work days missed among all work related injuries.  We hear the term CTS thrown around a lot these days, but just what is it?

Our wrists have eight rectangular bones in them called carpal bones.  These bones form a physical tunnel through which tendons, blood vessels, and the Median Nerve travel.  The median nerve innervates the skin and muscles our index, middle, and ring fingers (figure 1), but most importantly it innervates our thumb.  Because the this is a physical tunnel, there are limits to what can fit through it.  If one of the tendons becomes inflamed, it increases in size, putting pressure on other structures within the tunnel.  The median nerve is extremely sensitive to this increased pressure.

Figure 1- The carpal tunnel

Symptoms of CTS include:
  • Tingling or numbness of your entire hand.
  • Pain, tingling or numbness in the thumb, index, middle or ring fingers.
  • Pain that shoots from your hands up the arm as far as the shoulder.
  • A swollen or tightness feeling in your hands or wrists.

Sometimes you may also notice that:

  • One or more of the above symptoms are worse at night or in the morning.
  • Your hands or arms feel weak in the morning.
  • You may have trouble pinching or grasping objects.
  • You may have trouble performing detail tasks

Figure 2- The path of the median nerve

 

If you look at figure 2, you can see the path of the median nerve.  It arises from the spinal cord in our neck.  It then travels through our shoulder and down our arm.  If this nerve becomes entrapped at any other point, one can expect to see similar symptoms.  This is why carpal tunnel surgery doesn’t always work, and it is also why one shouldn’t jump to the conclusion of Carpal Tunnel Syndrome.  The surgical option consists of cutting the connective tissue band (Transverse carpal Ligament) at the wrist.  Current statistics indicate a 57% failure rate with these surgeries, with only 23% of these persons able to return to their previous duties.

These are not good odds for an invasive procedure. Instead, consider some less invasive options first, beginning with self-care. Things to begin with include: regular stretching (see below), ergonomic evaluation of your workplace, and of course treatment by a massage therapist. As an RMT, I am a soft tissue specialist and there is a lot that I can do to assess and treat nerve entrapment syndromes. Particularly I have had great success with Soft Tissue Release, Trigger Point Therapy and Deep Tissue Massage combined with Therapeutic Ultrasound.

Carpal Tunnel Syndrome falls under a group of ailments know as repetitive strain injuries. For more on this topic check out my article of this topic..

Carpal Tunnel Syndrome is an inflammatory condition, so after a long day or any continued activity I highly recommend dipping your forearms into cold or icy water in your kitchen sink for a minute (or longer if you can handle to cold). On the advice of your physician you can also consider anti-inflammatory medication as a short term aid in treating this condition.

In the meantime consider doing stretch A and B, a minimum of once per hour during your working day.  Stretch A can be even more effective if you stretch one wrist at a time, then (with the other hand) pull your fingers and thumb toward your body (increasing the stretch). For both of these stretches keep you elbow straight, and then hold the stretch for 10 seconds.

Figure A

Figure B

 

For more on these exercises and info on CTS, check out the American Association of Orthopaedic Surgeons site

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About The Author
Brian Fulton Brian Fulton is a Registered Massage Therapist that has been practicing in St. Catharines, Ontario since 1999. He is also an author and an educator. He conducts workplace health and wellness seminars, and was the health columnist for Dalhousie Peer magazine for over ten years. His book, The Placebo Effect in Manual Therapy- Improving Clinical Outcomes, printed by Handspring Publications, is available through Amazon.

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