Carpel Tunnel Syndrome
Carpal tunnel syndrome (CTS) is due to a build up of pressure around the median nerve as it passes through the carpal tunnel at the front of the wrist. This can lead to sensory and motor changes in the tissue that is supplied by the nerve. CTS is confirmed by electrical conductivity studies.
Carpal tunnel syndrome is classically thought of as a surgical condition. Unfortunately, this is all too often the case and a release of the flexor retinaculum (the ligament overlying the median nerve at the wrist) is performed.
The carpal tunnel is surrounded eight bones at the back and a ligament at the front and has 8 tendons as well as the median nerve running through it. Things can get a bit cramped and this puts pressure on the nerve.
Obviously, releasing the ligament at the front will release pressure on the nerve. However, before that other contributing factors should be assessed and treated. These include the joint mobility of the eight wrist bones and surrounding joints – if these are stiff, it can build up pressure in the carpal tunnel.
Soft tissue thickening can also increase pressure on the median nerve. The nerve is a dynamic structure – it is like a superhighway carrying not only nerve impulses, but also nutrients and waste products along its length. Pressure on the nerve restricts the transport of nutrients and waste and increases the nerve’s sensitivity – you feel pain, pins & needles & numbness more easily.
With this model in mind, think about stiffness at the neck joints. If the neck is stiff and restricts nutrient flow in the nerve, then the nerve will still become painful and you may feel pins & needles and numbness in the distribution of the median nerve. Thus it is essential to assess the neck and the whole pathway that the median nerve travels from the neck to the hand.
Appropriate treatment may include:
- Joint mobilizations at the wrist & neck to decrease pressure and improve joint mobility.
- Soft tissue mobilizations at the carpal tunnel tissue and along the length of the nerve where thickening is felt.
- Nerve mobilizations to loosen the nerve as it passes through the carpal tunnel and other surrounding muscles/joints along its path from the neck to the hand.
- Stretches to appropriate muscles that may compress the nerve and to the ligament that is at the front of the carpal tunnel.
- Modalities may also help but are of secondary value unless these causes are first addressed.
- Assessment of ergonomic factors at the worksite, home & car.
It is only after these avenues have been exhausted that surgery should be considered. Skilled manual therapy can help considerably with this condition by addressing the above areas.