Arm and hand pain: Carpal tunnel syndrome

Arm pain, Carpal tunnel syndrome (CTS), Hand pain, Repetitive strain, Repetitive strain injury (RSI), Self-treatment tips, Thumb pain, Wrist pain / Friday, April 2nd, 2010

wrist-painOf all the arm and hand pain conditions and syndromes that can be treated, carpal tunnel syndrome is the one that is most often misdiagnosed and the one for which unnecessary surgeries are most often performed. See other conditions and causes in the post on Arm and hand pain: A Checklist of Causes.

I was watching a popular television doctor a few days ago doing a bit on CTS. His explanation and the graphic use of tubes bound together was good. I didn’t entirely agree with his treatment suggestions, however, which were 1) shaking/fluttering your hand, 2) parafin bath, 3) wrist brace and 4) surgery. I also think he left out some important recent suggestions and practices.

As a Neuromuscular Therapist treating arm and hand pain daily in the Boston area, here are my thoughts and treatment suggestions.
There are nine tendons that go through the carpal tunnel at the wrist along with the median nerve. The space can get crowded when the tendons get irritated and swollen. The nerve that is usually protected by the cushion of the tendons becomes trapped in the middle of them, then compressed and irritated. Symptoms include pain, tingling and numbness, especially in the thumb, the first two fingers and the half of the ring finger.

If compression of the median nerve is truly what has happened, then the inflammation needs to be calmed down. Heat increases inflammation, so I recommend ice, but just icing the wrist isn’t enough. The muscles that attach to the tendons need to relax to take the pressure off the tendons and causing the irritation, so icing the muscles in the fleshy side of the forearm, treating them manually and stretching them gently away from the wrist will all help.

1) The finger flutter that the above-mentioned doctor recommended is effective. Hold your hands at your side, completely relaxed, then move your upper arms to gently shake your hands. This helps to relax the muscles attached to the tendons going through the carpal tunnel.  Releasing the tension on the tendons reduces the friction caused by the taut tendons rubbing against each other.
2) Blood and lymph flow are needed to remove the heat of the inflammation and take away the swelling from the irritating waste products that result from it. Bracing the wrist prevents movement, but it also reduces blood flow. I suggest that you use a brace only at night to avoid unconscious poor positioning of the wrist during sleep. Attach it  to prevent constrictions of blood vessels.
3) Massage strokes along the forearm toward the heart before sleep will help to release the day’s tensions, move irritating fluids away from the hand. In the morning it will restore blood flow to sleepy immobilized muscles.
4) It is very important to treat Trigger Points that might be causing the symptoms that are being diagnosed as Carpal Tunnel Syndrome.  Muscles as far away as the neck and shoulder can produce Trigger Point referrals that cause the same pains and sensations as real CTS. Releasing the muscle hyperactivity caused by repetitive use can relieve the pain.

5) Entrapment of the nerves and blood vessels in the thoracic outlet at the neck and shoulders and elsewhere down the neurovascular pathway can also cause CTS symptoms. Releasing tension and Trigger Points in the entrapping muscles may be necessary to stop pain.

The next post will be about cubital tunnel syndrome in the elbow.