Most sources will tell you that carpal tunnel syndrome is caused when the structures in the carpal tunnel become inflamed, thus compressing the median nerve. What they often (but not always) neglect to tell you is that compression anywhere along the median nerve can lead to symptoms of carpal tunnel syndrome.
In my clinical experience I have found that the Median nerve may be compressed at a different site in the neck, chest, shoulder, and forearm, or any combination of these sites.
The structures in the neck and chest are major players of compression because this narrow passageway of this region is crowded with blood vessels, muscles, and nerves. Many patients are found to have cervical disc degeneration, Thoracic Outlet Syndrome, or anterior rotated shoulders.
Prolonged and/or abnormal postures can usually be traced back to the cause of many of these conditions, if forceful injury can be ruled out.
Contributing factors
To be truly effective when treating Carpal Tunnel Syndrome one must look at the list of all possible contributing factors to find the cause and not just treat symptoms.
- Posture – A large number of cases can be traced to a forward head posture, rounded shoulders, pronated forearms, constant flexed wrist position during the day or while sleeping.
- Vitamin B6 deficiency – Pyridoxine is an especially important vitamin for maintaining healthy nerve and muscle cells.
- Pregnancy (edema) – Any condition in the body that would cause fluid retention or swelling could put excessive pressure on the nerves.
- Use of vibrational tools – Vibration Syndrome and Vibration-Induced White Finger, and Carpal Tunnel are major health hazards related to the use of smaller hand-held vibrating tools.
- Long periods of time in cold environments – Poor blood circulation would mean oxygen starved tissue and possibly undue pressure on the nerves.
- Repetitive movements – Do not allow adequate resting time for overworked muscles as well as the surrounding tissue.
- Soft tissue dysfunction – This classification would describe trigger points in the tissue that can send referral pain and lack of blood circulation to an area.
- Misdiagnosis or Lack of information about the condition – A misdiagnosis may include compression of the Median nerve in many areas not at the wrist. Patient education is also a key step in preventing a reoccurrence of Carpal Tunnel.
- Contributing factors that were not addressed – Few health care professionals discuss a list of contributing factors in addition to congenital predisposition and rheumatoid arthritis.
- Denial and taking responsibility for ones own actions – For many, this is most difficult. Knowing a particular action is harmful but continues anyway. An interesting passage titled “An Autobiography in Five Chapters” from the book “The Tibetan Book of Living and Dying” by Sogyal Rinpoche illustrates this point very well.
Prevention
Regardless of a person’s profession the best prevention for Carpal Tunnel Syndrome is to develop body awareness. This awareness helps to stay in tune with the body, so your work will be most efficient, with limited stress on your joints and muscles. This helps us to understand the physiology and warning signs of injury. By having this awareness you should realize that your muscles can be overworked and the stage will be set for injury to occur. It is also helpful to become aware of our own physical advantages and disadvantages. Develop an exercise and stretching program, and improve your posture.
Self help stretches
Try these stretches I use daily to retard the effects of overuse. If pain is present, ice massage is helpful in calming down the nerves.
Rubber Band Extension
Place a rubber band around all fingers. Open and close the hand for a maximum of 30 seconds. This exercise strengthens the extensor side and takes pressure off of the flexor side.
Thumb Extension Stretch
Using the index finger of the opposite hand push the thumb into extension to stretch, and then with the opposite thumb stroke the base of the thumb of the outstretched palm.
Wrist Extension Stretch
Put your arm straight in front of you. Make sure that your elbow is fully extended but not locked. Use your other hand to pull up and extend the hand by pulling up the fingers. Pull for five seconds, then release.
Forearm Wringing
Twist the forearm muscles with the other hand in both directions.
Scalene Stretch
Gently bring the ear towards the shoulder, and drop the opposite shoulder. Using the hand, push the side of the head toward the shoulder.
References:
Paul St. John. “Neuromuscular Therapy Pain Relief Seminars-NMT #4”.
Repetitive Motion Trauma Corporation. “Carpal Care”.
Norman Allard, D.C. & Glenn Barnett, D.C. “Carpal Tunnel Syndrome”.
Massage & Bodywork Quarterly, Fall 1993.
Benjamin M. Sucher, D.O. “Palpatory diagnosis and manipulative management of carpal tunnel syndrome”. The Journal of the American Osteopathic Association, August 1994.
Mark A. Pinsky. “The Carpal Tunnel Syndrome Book”. Warner Books, Inc. 1993.
Stanley Hoppenfeld. “Physical Examination of the Spine & Extremities”. Appleton-Century-Crofts. 1976.
Janet G. Travell, M.D. “Myofascial Pain and Dysfunction, Volume 1”. Williams & Wilkins. 1983.
Irene S. Gauthier. “The Science and Practice of Myomassology”. Irene’s Myomassology Institute. March 1995.
John F. Barnes, P.T. “Myofascial Release”.
Kate Montgomery. “If I only knew Carpal Tunnel Syndrome, The Invisible Threat”. Stay Well Audio Library. 1993.
American Academy of Orthopedic Surgeons Public Information. AAOS On-Line Service. February 1999
