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Carpal Tunnel Syndrome

Carpal tunnel syndrome, or CTS, is something you are probably familiar with.  Affecting approximately 3-6% of the general population, CTS is usually linked to highly repetitive tasks like heavy manual labor, or typing and desk work.  Characterized by numbness, tingling, or burning sensations in the thumb and fingers, carpal tunnel syndrome is the most common nerve entrapment found in the body.

While there is a lot that we do know about CTS, unfortunately it hasn’t made fixing it any easier.  Successful conservative treatment of carpal tunnel syndrome have been estimated between 3 and 70%!  That is quite a wide range of success to say the least!  The problem in successful treatment may lie in the diagnosis.

Most commonly, CTS is characterized as entrapment of the median nerve in the carpal tunnel of the wrist.  Often times this is not the case.

The median nerve forms in the axilla (armpit) by joining nerves that originate in the neck.  After forming, the median nerve continues its path through the upper arm, into the elbow, through the forearm, and finally through the carpal tunnel and into the hand.  Along this path, the nerve passes through multiple structures before arriving at the carpal tunnel in the wrist.

Median Nerve Pathway
Median Nerve Pathway

When healthy, the nerve glides along other muscles, tendons, and other soft tissue structures without problem.  With overuse and some other conditions, the nerve can become glued and entrapped by adhesion to these structures.  When nerves become entrapped, they cause tingling, burning, and numbness symptoms.  This is where the problem lies in most cases of classic CTS!

Overuse Cycle

While the carpal tunnel, itself, gets most of the recognition for this problem, the median nerve can become entrapped anywhere along its path to the wrist and hand.  The difficulty with treatment is finding where this entrapment exists.

Therapies like drugs, injections, and splinting may offer short term relief, but do nothing to actually fix the entrapment.  The same holds true for stretching and exercise.  Surgery should always be used as a last resort.

In order for resolution of CTS, the nerve must be freed from the entrapment, if present, in the soft tissues of the neck and arm. Fortunately, there are some at home movements for carpal tunnel to see where the entrapment may exist:

Cervical Flexion.  To start, stand with your back flat against the wall including the head.  Start by tucking the chin to the neck without moving the head off the wall.  Note any symptoms into the neck, shoulders, or arms.  Next move further into flexion by tucking the chin to the sternum.  Inability to tuck the chin to the chest, or symptoms into the shoulder or arm can be a sign of entrapment in the neck.

Healthy cervical flexion.
Healthy cervical flexion.

Shoulder Abduction.  Stand upright with the arms along the side.  Slowly bring the arms up to the ears by moving the arms in a motion similar to a “jumping jack.”  The upper arm should touch the ear.  Anything short of this motion or pain or numbness into the hands may be a sign of entrapment.

Shoulder Abduction
Shoulder Abduction with right side more restricted than left. (Note upper arm proximity to ears)

Wrist/Finger Extension.  Place the forearm flat along the wall with the elbow 90 degrees to the shoulder.   Pull back on the wrist until it is 90 degrees to the forearm.  Now, pull back on the fingers.  They should be roughly 65 degrees to the wrist.  Note symptoms. Any motion short of the noted ranges is positive, along with pain, tingling, or burning sensations can be a sign of entrapment in the forearm or wrist.

Wrist Extension
Healthy Wrist/Finger Extension

As mentioned earlier, most conservative treatment fails to diagnose properly, and thus, fails to provide proper treatment to fix carpal tunnel syndrome.  Manual therapy has been shown to be effective for treatment of nerve entrapment.  Carpal tunnel syndrome is progressive in nature, and ultimately leads to surgery in far too many cases where it could have been prevented.  For those suffering with CTS symptoms it is highly recommended to seek proper treatment as soon as possible.

At Thrive Spine and Sport, we focus on finding and fixing nerve entrapment!  If you have been struggling to find relief from carpal tunnel syndrome, call our office today to set up an appointment at 319-423-0925, or fill out the appointment request on this page.  If you have any questions, feel free to email myself at dr.cody@thrivespineandsport.com.

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