My Humbling Experience w/ Carpal Tunnel Syndrome

 Someone close to me was dealing with this problem & I did not know how to help them. As a 2nd-year DPT student, I felt as though I should have had the answers and the fix, but I blanked out–I had nothing. The previous day, I just finished an orthopedics practical on the upper extremity. Therefore, my mind went straight to “what special test do I need to do for carpal tunnel?” Something as simple as neutral wrist position and good posture slipped my mind. That humbling . experience is why I’m writing this blog. This is what I should’ve told my “patient”.

median nerve.jpegWhat is carpal tunnel? There is a narrow channel in the wrist made up of carpal bones and flexor retinaculum, also known as transverse carpal ligament.These borders are very rigid, leaving very little room for wrist structures to expand. The contents that travel through the carpal tunnel include nine tendons that flex the fingers and thumb, as well as the median nerve.

median-nerve-21-638What is carpal tunnel syndrome? Numbness, tingling, and weakness in the hand occurs when the median nerve is squeezed or compressed from pressure in the wrist. The median nerve controls motion in the thumb, index, middle, and ring finger, but sensation in the thumb, first two fingers, and only half of the ring finger. Next time you feel tingling in your hand, pay close attention to the sensation on your ring finger. If the median nerve is affected, the half closest to your pinky should have normal sensation.

Why & how does it happen? Pressure on or irritation of the median nerve is mainly due to any action that makes the tunnel smaller. Combined with repeated motion in the compromised position, the contents inside the tunnel have less room, causing them to rub or pinch against each other, making them irritated inflamed, swollen, and painful.

Hand position and repeated movement such as typing, manufacturing, construction, or playing almost any musical instrument  may contribute to carpal tunnel syndrome. A bent wrist with repeated action such as typing or playing the piano is an easy way to close the carpal tunnel and irritate the median nerve. When the wrist is bent, the carpal bones approximate together, making the tunnel smaller. The narrowed tunnel combined with repeated movements irritate the tendons and median nerve, causing swelling and inflammation.  This is what puts pressure on the median nerve causing pain, numbness, tingling, or weakness. Carpal tunnel syndrome can also be caused by swelling itself. Swelling can be caused by health conditions such as hypothyroidism, rheumatoid arthritisdiabetes, and pregnancy can also be a proponent of carpal tunnel.

4704709But wait!  We must remember the body is interconnected. Carpal tunnel can also mask itself as nerve entrapment or double crush syndrome in other places in the body. The median nerve starts at the neck and runs down to the fingers, therefore the median can be pinched at the neck, shoulder, or arm.  Neck position can close the foramen in the neck, irritate the nerve root, and cause sensation down the arm and into your hand, which can be mistaken as carpal tunnel syndrome. Further down the chain, the median nerve can be trapped under the scalenes or pec minor due to a forward head posture and rounded shoulders. Next in line, there can be impingement of the median nerve in the arm. This can be due to excess tension in the biceps or forearms muscles pinching on the median nerve from overuse.

Fix: Let’s face it, your pain will not make you contact me, but not getting sleep because of your carpal tunnel pain will. Once that time comes, a physical therapist is educated to determine if your problem is truly carpal tunnel syndrome or double crushed syndrome. After that, the PT may perform specific manual techniques, nerve glides and train you on exercises to reduce your symptoms and get you back to a full night’s rest. In the meantime, use a wrist splint at night to decrease your symptoms until you can see your local physical therapist. (P.S. Yes, I did end up helping my patient.) 

For more information on this subject see Dr. Christopher Ritchie DPT

Thank You for Your Attention.  

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Edited: Ffrancesca Famorcan

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To learn how Physical Therapy can serve you, see GetPT1st ,  Greg Todd , Renewal Rehab  Paul Gough Physio RoomsFunctional Patterns  ,  Aaron LeBauer , Kelly Starrett,  The Movement Fix, Anatomy Trains,  The Prehab Guys,  Modern Manual Therapy,   Dr. Ben Fung & Updoc Media ,  Andrews University Physical Therapy

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