What is Carpal Tunnel Syndrome?
The carpal tunnel is a canal formed by the small bones of the wrist and a band of connective tissue called the flexor retinaculum. This band acts as a harness for the tendons, nerves, and blood vessels running through the carpal tunnel into the hand.
Carpal tunnel syndrome results when the median nerve passing through the canal is compressed by the surrounding structures. This produces numbness and tingling in the thumb and first two fingers. Several related conditions can be misdiagnosed as carpal tunnel, or can exist simultaneously with carpal tunnel (read below).
What Causes Carpal Tunnel Syndrome?
There are many reasons why the median nerve may become compressed. Systemic conditions such as diabetes (or even pregnancy) can cause changes to the circulatory system, which can lead to swelling in the wrist. Often, it is the result of an overuse injury. When tendons in the forearm are overused, they may become swollen. Similarly, the flexor retinaculum begins to fibrose from overuse, compressing the structures in the tunnel.
Treating CTS: Overuse Injuries
Manual therapy is highly effective in treating carpal tunnel syndrome resulting from an overuse injury, often precluding the need for surgery. Overuse of the wrist results in adhesions in the tendons of the forearm and hand. The tendons become thickened, effectively crowding the median nerve and causing compression. The irritation from this crowding causes swelling, further exacerbating the pressure on the nerve. In response to this swelling, the flexor retinaculum begins to thicken, tightening its hold on the nerve and tendons. As you can see, it is a vicious cycle.
Medical massage softens these tendons and reduces swelling in the area. Redundant fibrous cells are reabsorbed into the bloodstream and are swept away to be recycled by the body. A similar softening treatment is given to the flexor retinaculum that binds the wrist. The result is smaller and more agile tendons, more flexible retinaculum, and ultimately, more space for the median nerve.
The upper arm and neck will be treated for trigger points that may be reducing nerve function or circulation closer to the wrist.
Treating CTS: Systemic Conditions
Medical massage can also provide temporary relief of carpal tunnel syndrome related to swelling. Circulatory conditions such as diabetes, hypothyroid, and pregnancy may create swelling in the wrists, and lead to carpal tunnel syndrome. Massage therapy can temporarily relieve the symptoms of this swelling by increasing blood flow back to the heart.
Related Conditions
Similar conditions are often diagnosed as CTS. In order to achieve complete results with CTS pain, all presenting conditions must be treated. The most common.
— Thoracic Outlet Syndrome
— Pronator Teres Syndrome
— Scalene Trigger Points
Exercise and Follow-Up
In order to prevent future recurrence, postural disorders, and repetitive stress associated with the workplace or with other activities must be addressed. The therapist will suggest simple postural adjustments to prevent future pain. She will also provide the client with a stretch protocol, which can be performed daily to eliminate future occurrences.
Carpal Tunnel Treatment Protocol
— Medical massage to wrist, forearm, shoulder, and neck
— Stretching protocol
— Postural reeducation
— Ergonomic mouse
— B6 supplementation or referral to a nutritionist