Carpal Tunnel Syndrome (“CTS”) is a common condition that occurs in about 1 in 500 people in the United States, and as high as 1 in 80 in the United Kingdom.[footnote]Kim Edward Leblanc, Wayne Cestia (15 Apr. 2011). Carpal Tunnel Syndrome – American Family Physician. Aafp.org. Retrieved from http://www.aafp.org/afp/2011/0415/p952.html[/footnote]
It is more common in women than men, and the average age of onset is 40–50 years. Women are at least three times more likely than men to develop CTS, and caucasian people are more likely than other ethnic groupings to develop CTS.[footnote]Ashworth, Talavera, Foye, Meier, Sucher. (24 Apr. 2016). “Carpal Tunnel Syndrome: Background, Pathophysiology, Epidemiology.” Emedicine.medscape.com. Retrieved from http://emedicine.medscape.com/article/327330-overview#a6[/footnote]
CTS is a classically defined as a compression of the median nerve as it passes through the carpal tunnel, the set of bones at the base of the palm. However, the symptoms of numbness, tingling, pins & needles, and hot or cold sensations in the forearm, wrist and hand can often be caused by compression of the median nerve much further up the chain.
Think of it this way: if you have several kinks in a garden hose, by the time it gets to the last kink near the nozzle the flow will be much more diminished than if that last kink were the only blockage.
Thus, in order to return full function to the nerve and alleviate the symptoms, we need to check the entire nerve pathway, from the neck all the way to the fingers.
If more than one location is compressed, then simply releasing the carpal tunnel may not resolve your pain when there are several more further up the chain.
Assessment
As always, the first thing to do is go through your history – mainly to find out if there might be any reason not to proceed, or if we should adapt any methods, in order to ensure you will be safe for treatment.[footnote]Simpson, Marion A (n.d). Painful numb hands | Medical Journal of Australia. Mja.com.au. Retrieved from https://www.mja.com.au/journal/2011/195/7/painful-numb-hands[/footnote]
During assessment I begin at the neck, seeking any sites where the median nerve may be compromised:
- The spinal nerve roots
- Brachial plexus of the neck
- Thoracic outlet of the shoulder
- Bicipital aponeurosis of the arm (tendinosis)
- Pronator teres muscle compression
- And finally the carpal tunnel.
There may also be misalignment of the eight carpal bones, and it may be worth mobilising the bones so that they sit and move correctly without aggravating the surrounding muscles, nerves and blood vessels.
Treatment
Beginning at the site closest to the spine, we sequentially release all of the places where assessment indicates there is a nerve compression.
In the case of the neck vertebrae, we may gently mobilise the facet joints (no cracking, never) and stretch the muscles that may be compressing the joints. This re-sets the neck.
At the brachial plexus we use active stretching in a way that feels vaguely satisfying to release the scalene muscles.
At the thoracic outlet we use myofascial release and active stretching to lengthen and release the pectoralis minor and surrounding muscles, re-setting the shoulder.
Then we might release the biceps brachii and pronator teres muscle near the elbow, freeing yp the median nerve as it passes through.
At the wrist we may do some carpal joint mobilisations and myofascial release to loosen the carpal tunnel itself. We’ll probably stretch out and massage the whole hand, just to ensure the joints are free and open.
All of this is mixed in with more traditional relaxing massage movements so that the experience becomes enjoyable. After all, if you feel relaxed then you are more open to the changes we’re seeking to make.
Sources:
- Leblanc, Cestia (15 Apr. 2011). Carpal Tunnel Syndrome – American Family Physician. Aafp.org. Retrieved from http://www.aafp.org/afp/2011/0415/p952.html
- Ashworth, Talavera, Foye, Meier, Sucher. (24 Apr. 2016). “Carpal Tunnel Syndrome: Background, Pathophysiology, Epidemiology.” Emedicine.medscape.com. Retrieved from http://emedicine.medscape.com/article/327330-overview#a6
- Simpson (2011) Painful numb hands | Medical Journal of Australia. Mja.com.au. Retrieved from https://www.mja.com.au/journal/2011/195/7/painful-numb-hands