Carpal Tunnel Syndrome
Carpal tunnel syndrome is a nerve impingement or nerve compression condition resulting in pain that effects about 3% of women and 2% of men. Studies have shown that women are three times as likely to get carpal tunnel syndrome than men.
Carpal tunnel syndrome (“CTS”) occurs when repeated bending of the wrist and hand results a repetitive stress injury (“RSI”) to the tendons that run through the carpal tunnel of the wrist.
Specifically, the tendons passing through the wrist area become inflamed from repetitive overuse, and the protective sheath around each tendon swells. This swelling narrows the small carpal tunnel, putting pressure on the median nerve which also travels through this tunnel. It is this nerve compression that causes carpal tunnel pain.
Carpal Tunnel Syndrome – You’ve got it … or Do You?
The most common upper extremity nerve compression disorder, carpal tunnel syndrome is can be misdiagnosed by a physician.
Proper diagnosis of CTS is made challenging due to symptoms that may come and go, and pain that may not always be very specific. These can be contributing factors in a wrong CTS diagnosis.
A lesser known disorder, Pronator Teres Syndrome – is also a median nerve compression issue –and produces almost identical symptoms as carpal tunnel, leading to unfortunate misdiagnosis. However, in this syndrome, the nerve compression is located just above the inside of the elbow or below the elbow and/or crossing the arm … but pain is felt further down the arm in the wrist, hand and/or fingers.
In cases where surgery is recommended to relieve what is thought to be carpal tunnel pain, it is not uncommon for the pain to return post-surgery, due to an incorrect initial diagnosis. Sadly, the surgery and medical costs cannot be undone, and the pain as well as the person’s frustration, returns.
A lesser known disorder, Pronator Teres Syndrome – is also a median nerve compression issue – and produces almost identical symptoms as carpal tunnel, which can unfortunately lead to carpal tunnel misdiagnosis.
Recently, surgeons at the Mayo Clinic discovered another cause of wrist pain that may be confused with carpal tunnel syndrome, called a UT (ulnotriquetral) ligament split tear.
This injury also causes similar pain to carpal tunnel, but the tear presents with much more specific indications, aiding in a proper diagnosis of this condition.
Bottom line, just because your wrist, hand and/or finger hurt, don’t jump to the conclusion that you must have carpal tunnel … it could be something else altogether. When in doubt, get a 2nd or even 3rd opinion, especially if surgery has been brought up as an option.
It is highly suggested that you also consult with a skilled medical massage therapist. Massage Therapy can help you avoid surgery altogether, and can make a real difference in reducing your pain and helping you more effectively manage this condition.
Carpal Tunnel – Symptoms
Symptoms of carpal tunnel syndrome vary in degree, usually depending on the length of time a person has gone without seeking treatment. These symptoms include tingling, itching, burning, or numbing sensation along the palm and fingers, particularly in the thumb, index, and an entire half of the middle finger.
Pain symptoms can be worse at night or first thing in the morning due to person sleeping with their wrist in a bent (flexed) position, which is normal. It’s this bent wrist position that puts more stress on the inflamed tendons.
As the condition worsens, fingers may feel swollen even if they are not, hands may become too weak to firmly grasp things, and the person may not be able to differentiate between hot and cold sensations.
Carpal Tunnel Syndrome – Causes and Risk Factors
In addition to women being at a higher risk than men, those with diabetes, metabolic disorders, or other medical conditions that affect the nervous system are also at a higher risk. Risk of carpal tunnel syndrome also increases with age, and children are almost never affected by it.
Professions that have a high risk factor include: manufacturing, data-entry, sewing, cleaning, and meat-packing industry workers among others repetitively bending/flexing their wrists in their work.
As previously mentioned, carpal tunnel syndrome is caused by repeated motions of the hand or the wrist. Other potential causes can include injuries to the wrist joint, stress, arthritis, diabetes, and hormonal changes due to pregnancy or hormone disorders.
Carpal Tunnel Treatment Options
There are a number of different treatment options available to patients who are diagnosed with carpal tunnel syndrome depending on the severity and other underlying factors.
If there are other issues such as arthritis, diabetes, or obesity, it is important that these issues be resolved first since carpal tunnel syndrome can reoccur if these other issues not initially resolved. In nearly all cases, the affected wrist or wrists should be completely rested for at least two weeks before any treatments are started.
Surgical Treatment Options
One of the most common types of all surgical procedures in the United States is carpal tunnel release with over 230,000 procedures performed every year. This is recommended for symptoms that last for more than 6 months.
Open release is the most common type of carpal tunnel surgery and involves cutting the carpal ligament to make the tunnel larger. It can be done as an endoscopic procedure which tends to reduce post-operative healing time and pain.
While surgical procedures offer a quick relief for symptoms, if care is not taken over the months following the procedure to do all the necessary physical therapy, the symptoms can reoccur, especially when there has been a misdiagnosis.
Surgery can lead to possible side effects including infections, nerve damage, pain, and stiffness caused by scar tissue formation. Because of this, non-surgical intervention tends to be a more preferred and conservative treatment option.
Surgery, in this author’s opinion, should always be the last option. Try every other non-surgical approach you can – massage, physical therapy, acupressure/acupuncture, and others, before resorting to surgery.
Non-Surgical Treatment Options
There are a number of options to choose from outside of surgery for carpal tunnel syndrome. There are several different types of medications that have been proven effective, particularly anti-inflammatory NSAID (non-steroidal anti-inflammatory drugs)medications.
Physical therapy is also commonly used to help stretch the wrist and strengthen the hand muscles. Some alternative options include acupuncture and chiropractic intervention, but there are not enough studies available on these to definitely say that which are the best options. At the end of the day, it depends on what treatment with which you are the most comfortable and confident.
Massage Therapy for Carpal Tunnel
One of the best ways to help those who are experiencing carpal tunnel syndrome is to include massage therapy as part of a physical therapy regimen. Studies that have been done on people with carpal tunnel syndrome have shown that hand and arm massages help in several ways.
The first way massage therapy helps is to relax the muscles that are in the hand and wrist. Tension in the muscles causes more pain and can further constrict the carpal tunnel which is why relaxing the muscles is so important.
Another way that massage therapy helps those suffering from carpal tunnel syndrome is that it increases blood flow to the hand. An increased blood flow to a certain area encourages the body to heal that area if there has been damage done, and it also helps to ease the pain.
An increase in blood flow may also ease pain by reducing inflammation which is sometimes may be caused by a lack of proper blood circulation.
A knowledgeable massage therapist will not just focus on the wrist and hand. The nerve that runs through the carpal tunnel also runs through the rest of the arm, which is why it is vital that the entire neck, shoulder and arm … and even the rest of the body receive attention.
This “extended area” treatment is also important because there can be more than one area along the median nerve pathway where this nerve may be compressed and contributing to carpal tunnel pain.
When all of the muscles in a person’s neck, shoulder, arm, wrist, and hand are correctly balanced and working properly, the release the pressure in the carpal tunnel and the associate pain relief is much more likely to be successful.
When choosing a massage therapist for carpal tunnel syndrome, be sure to find a medical massage therapist, or at the very least, a massage therapist who has experience treating upper extremity nerve compression issues of the neck, arm and hand.
Many people think of massages as something done to make you relax, but the fact is that a good massage therapist can manipulate the muscles in a way that can be beneficial to your health. It is also a good idea to discuss your massage therapy choice with your primary care doctor.
Carpal Tunnel Prevention
Once on the path to recovery from carpal tunnel syndrome, there are a few things that a person should do in order to maintain their new pain-free life.
There are a quite a few simple things that can be done to prevent the reoccurrence of carpal tunnel syndrome, such as relaxing your grip when writing or performing other hand-related tasks, taking frequent breaks when working with your hands, alternating tasks, improving your posture, etc.