The Carpal Tunnel and Its Many Avenues

Do you, like the vast majority of the human population, operate a computer from time to time? Have you ever experienced discomfort in the wrist and forearm from too much time typing your many emails, status updates, blogging and what have you? The pain probably went away after you stepped away from the computer and did something else. The discomfort or pain is your body’s way of saying “answer that request later” or “step away from the computer and back up slowly partner.” Many times it is not as easy as that. Modern technology has placed at our fingertips many diverse jobs that require long hours in front of our desk and in front of our computer screens. Deadlines loom as projects must continue, numbers must be crunched, blog entries typed and then we spend an inordinate amount of time at our keyboard. You are most likely reading this at a computer screen right now. Stop and take a look at your hand position. Your wrists are probably a little extended just resting your hand on the keyboard page-down arrow or flexed over the mouse that will enable you to move to the next screen. Imagine holding these positions for hours at a time, repetitively throughout the days and weeks. You may begin to experience tightness in the wrist and forearms and eventually compression of a nerve which would then lead to real pain and not just slight discomfort. If allowed to get out of control, the repetitive actions could result in what is clinically known as Carpal Tunnel Syndrome – a condition that results from median nerve compression in the carpal tunnel at the wrist. CTS is the most common entrapment syndrome in the arm… it is also one of the most misdiagnosed maladies in the arm.

There are many causes for CTS. Among the most prominent of which is the aforementioned repetitive flexing and extending of the wrist which can lead to swelling and the formation of thickening tissues and if left untreated, chronic fibrosis. Fractures of the wrist can also result in CTS as well as systemic conditions such as diabetes, rheumatoid arthritis, and hypothyroidism. Many pregnant women as a result of swelling can develop CTS that may not resolve until the postpartum stage. There is some belief that a vitamin B6 deficiency which results in smaller connective tissues may be a cause as well. CTS often only seen in the dominant hand, exhibits thenar muscle wasting. The thenar is the muscle at the base of the thumb and weakness can result in clumsiness with simple tasks such as buttoning clothes or holding a mug. As a result of median nerve compression and subsequent malnourishment of the tissues, metabolic waste can build up causing fibrous tissues in the forearms- another CTS symptom. A differentiating characteristic of CTS is the presence of nocturnal pain that wakes you up. This is most likely due to sleeping with the wrists in a flexed position and compressing the median nerve. It is important to note that it is not only computer workers that are susceptible to CTS. Butchers/meatpackers and assembly line workers are vulnerable to CTS as well as anyone who repetitively uses their hands... massage therapists I am looking at you.

Depending on the severity of the symptoms, doctors may prescribe anti-inflammatory's or in worse cases steroid injections but it is also important to point out that with any steroid injection, the pain relief is temporary and overtime rendered less effective. Splinting may be prescribed for CTS and in severe cases surgery may be necessary. This is the part where misdiagnosis becomes a scary reality. Often CTS is diagnosed with electromyography (EMG) which measures nerve conduction and if the median nerve shows a diminished conduction time, the patient is slapped with a diagnosis of CTS. But could it be something else? There is a phenomenon called double crush in which other syndromes are involved and increase susceptibility to CTS. In some cases these other syndromes or issues are the actual and only cause of the pain and discomfort.

Pronator Teres Syndrome is also a condition in which the median nerve is compressed by the Pronator Teres muscle. The Pronator is a forearm muscle that enables you to move your wrist and forearm out of a neutral position and rest your hand on a flat surface (like a keyboard or assembly line or massage table). The pronator also makes dribbling a basketball possible. Unlike CTS, PTS is exacerbated by elbow movement and not wrist movement and pain is felt at the elbow. Thoracic Outlet Syndrome is a condition that not only involves compression of the median nerve but also the radial, ulnar and other nerves emerging from the brachial plexus as well as vascular structures that can become entrapped by tight muscles and tissues in the neck and chest or impinged between the clavicle and 1^st rib. Compression of spinal nerve roots for C6 and C7 can refer pain to the thumb, index, and middle fingers (also innervated by the median nerve), and the lateral forearm and produce biceps and triceps weakness with pain in the neck. In some cases, CTS symptoms may be only symptoms of a much bigger disorder. There have been documented cases where surgery used for CTS and was a complete failure because though CTS symptoms were present in the wrist, the actual problem was located further up the arm, in the shoulder or at the neck.

By now most of our loyal readers are probably wondering, “Ok, but what can massage therapy do to help alleviate these symptoms?” Massage therapy can be a great benefit to those who suffer CTS or any of the other above syndromes if the focus is on decreasing swelling and tone, and addressing any adhesions or trigger points that are present. By reducing stress and restrictions, massage nourishes fibrous tissues, maintains range of motion, and reduces the pain associated with CTS. If you are experiencing prolonged pain and numbness of the forearm, wrist, thumb or middle/index fingers, you may assuage the pain by running cool or warm water over the hand until you can see your massage therapist. It is out of the scope of practice for a licensed massage therapist to diagnose any condition so an EMG from your physician may be necessary. However, when it comes to relief from the pain and discomfort of CTS, there are many avenues to travel. Besides massage, acupuncture, physical therapy, and exercise are healthy alternatives to invasive procedures most of the time. Good luck and long may you use your hands.

source: http://blog.legitmassage.com/