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Medicine

Carpal Tunnel Syndrome: Is Surgery Necessary?


By Sarah Mertyris, CMT

“Carpal tunnel” has become one of those catch phrases that people toss around like a Frisbee when they are referring to pain in the arm, wrist and hands.  People say, “I have carpal tunnel.”  Well yes, technically we all have a carpal tunnel; two in fact!

The carpal tunnel is an anatomical compartment located at the base of the wrist.  Nine flexor tendons and the median nerve pass through the carpal tunnel which is surrounded on three sides by the carpal bones and covered on top by the transverse carpal ligament; forming an arched tunnel.  The syndrome itself is defined by a compression of the median nerve.  Let’s take a moment to learn more about it…

Symptoms of Carpal Tunnel Syndrome (CTS):

  • Burning, tingling, itching, and numbness in the palm of the hand and the thumb, index and middle fingers
  • Decreased grip strength

Symptoms usually start gradually and build, and are prevalent at night since most people sleep with flexed wrists; a position that compresses the carpal tunnel.  Numbness is by far the number one and most accurate of these symptoms as it is a clear indication of nerve impingement.  The other more painful symptoms may confuse a CTS diagnosis because they can be attributed to other nerve impingement conditions of the neck, upper torso, arm and forearm.

Causes of CTS:

  • Congenital Disposition: born with a carpal tunnel that is small
  • Trauma or Injury: can cause swelling in or a disfigurement of the tunnel
  • Over activity of the pituitary gland, hypothyroidism, and rheumatoid arthritis
  • Mechanical Problems in the wrist due to work stress and repeated use of vibrating hand tools
  • Pregnancy
  • Diabetes
  • Obesity
  • Tumors or Growths

Although it is still considered controversial as to whether repetitive stress in the work place is a true cause of CTS; studies have not been done to scientifically prove a causal relationship between activities like keyboarding and CTS.  Repeated motions can result in repetitive motion disorders such as bursitis and tendonitis.

At Risk Groups:

  • Women are 3 times more likely to have CTS due to smaller wrist structures and pregnancy
  • Persons with diabetes and/or obesity
  • Persons performing assembly line work

Diagnostics that physicians use to determine if you have CTS:

  • Phalen’s Maneuver: flexing the wrist at a 90° angle and seeing if numbness occurs within 60 seconds.
  • Tinel’s Sign:  lightly tapping the skin over the flexor retinaculum to elicit tingling.
  • Durkan Test: applying firm pressure to the palm over the nerve for up to 30 seconds to elicit numbness or tingling sensations.
  • Electrodiagnostic tests: nerve conduction studies.
  • Ultrasound: can show impaired movement of the median nerve.
  • MRI: can show merely the anatomy of the wrist.

There are signs and symptoms to keep in mind when trying to determine whether you have CTS or something else going on.

  • Only the thumb, index and middle finger should be involved.  The ring and pinky fingers are innervated by the ulnar nerver that does not pass through the carpal tunnel and is most likely going to be impinged farther up the line in the shoulder girdle.
  • The thenar eminence (the meaty part just below the thumb) should not go numb either as it also innervated in part by the ulnar nerve, although it may suffer from atrophy due to the condition.
  • Pain is far less an indicator of CTS than numbness is.  A predominance of wrist and arm pain can be an indication that another musculoskeletal condition is at play.

If you suffer from the symptoms listed above, it is important that you become knowledgeable about CTS as well as other conditions that affect the innervation of the arms and hands.  As in most cases in the medical world today, you must be your own advocate for the proper care and treatment of your condition.

As massage therapists we often see clients that have been misdiagnosed with CTS and have undergone extensive surgeries, only to have their symptoms return after surgery.  There are many other muscular causes for “CTS-like” symptoms which can be eliminated through manipulation of the soft tissues: massage.  HOPE Wellness Institute would like the opportunity to work with clients before they consider surgery to see if their conditions can be improved and even wiped out with a much gentler, inexpensive and far less traumatic form of treatment.

Referenced articles:

http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm

http://en.wikipedia.org/wiki/Carpal_tunnel_syndrome

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