Arm and hand pain: A Neuromuscular Therapy point of view

Arm pain, Carpal tunnel syndrome (CTS), Chronic pain, Hand pain, Neuromuscular therapy, Repetitive strain injury (RSI) / Tuesday, March 17th, 2009

wrist-supportComputer users, chefs, musicians and people who work with their hands are often diagnosed with Carpal Tunnel Syndrome (CTS) when the injury is more likely Repetitive Strain Injury (RSI). Overuse without proper self-care makes them victims of a chronic debilitating injury that can be hard to treat if it isn’t caught and properly treated early. Surgery can be avoided.

As a Neuromuscular Therapist, how do I think about the Repetitive Strain Injuries like Carpal Tunnel Syndrome?

Pain from local injury in the forearm must always be treated first, but that is only symptom relief. The real problem almost always starts higher up in the body in the shoulder girdle, chest and neck. The combination of sources leading to pain is the puzzle to solve. Because I am an NMT, this is what I look for:

  1. Local injury to muscles and inflammation of nerves causing pain, tingling and numbness in the forearm and hand.
  2. Trigger Points that form from overuse in the upper extremity and refer symptoms to the forearm and hand.
  3. Entrapment of blood vessels and nerves in the forearm and in the front of  the neck, around the collar bone and in the upper chest and armpit (axilla) that become compromised by tight muscles or by taut bands formed by Trigger Points. 
  4. Ischemic areas (like a local anemia) where the muscles have become tight and unhealthy from insufficient blood flow.

All of these factors can vary in their effect on the health of the arm by how tight the muscles are, where entrapment is occurring and how serious the Trigger Points have become (active vs latent). Impairment of blood circulation means that the body is not bringing nutrients, healing cells and oxygen to the forearm muscles that enable them to work while remaining healthy. In addition, waste products cannot be efficiently removed from around the working muscles so a toxic environment is created that can cause inflammation, pain and ill health in the cells that form the soft tissue. More seriously, impaired or irritated nerve pathways can be established that prevent effective communication between the arm and the central nervous system. These can be difficult to reestablish if there is a long-term chronic condition. Those who seek treatment early heal more readily, but  the longer a patient goes without satisfactory intervention, the longer it will take to heal.

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