Carpal Tunnel Syndrome

Symptoms

Tingling, numbness, weakness and pain in the hand and wrist. The hand symptoms are going to be in the thumb, index and the index side of the middle finger. At first, symptoms only bother you at night or while doing repetitive motion but often progress to be constant.

Cause

Carpal Tunnel Syndrome (CTS) can be caused by any repetitive motion that stresses the upper extremities of the body. The increased use of computers has resulted in an epidemic of injuries to the hands, arms, shoulders, and neck. It can also be caused by bike riding. In Truckee the use of Handheld devices has irritated carpal tunnel syndrome. The increased intensity and duration of the work is also a substantial contributor to the problem.

The thousands of repeated keystrokes and long periods of clutching and dragging with the mouse cause chronic irritation to soft-tissue (nerves, muscles, ligaments, fascia, and tendons). This irritation creates friction and pressure, which eventually leads to small tears within the soft-tissue. These in turn cause inflammation, decreased circulation, swelling (edema) and scar tissue.

 
Hand injury
carpal tunnel.jpg
Classical Definition of Carpal Tunnel Syndrome

The classical medical definition of Carpal Tunnel Syndrome (CTS) is: ‘The impairment of motor and/or sensory function of the median nerve as it traverses through the Carpal Tunnel.


The Problem with Tradition!

Splinting provides temporary relief, especially at night, but over the long-term results decreased levels of oxygen reaching tissues. Poor oxygen levels are a primary accelerant of scar tissue creation, which leads to the formation of increased levels of adhesions between soft-tissues. As well, strength in the arm is decreased due to disuse and muscle atrophy. These adhesions will also lead to imbalances in body mechanics due to other muscles trying to compensate for the weaker muscles. These imbalances lead to further friction and adhesion formation.

 
carpal  tunnel.jpg
Inaccurate Diagnoses 

The median nerve is a peripheral nerve which runs the entire length of the arm. This is the nerve that is most commonly associated with carpal tunnel symptoms. Most traditional treatments focus upon the entrapment of the median nerve at the carpal tunnel area(which is in the wrist). Research is showing that this traditional emphasis upon the carpal tunnel area is both inaccurate and ignores the greater picture. Dr. Michael Leahy (Creator of ART) reported that, in over 500 cases of peripheral nerve entrapment, only two cases involved the actual carpal tunnel. In the majority of carpal tunnel syndrome cases, the nerve entrapments actually occur further up the arm, closer towards the elbow. Our own clinical research has confirmed these findings. Conventional treatments rarely address these other entrapment sites, choosing instead to focus solely upon the carpal tunnel region. 

Unfortunately, many practitioners are unaware of this information and continue to use standard medical tests and procedures that focus solely upon the area of the carpal tunnel. Non-specific, inaccurate testing methods often lead to the misdiagnosis (and treatment) of just a single entrapment site at the median tunnel, when in fact, nerve entrapments can occur along the entire length of the carpal nerve, from the shoulder to the tips of the fingers. Thus, it is no surprise that most medical procedures achieve very poor results when treating CTS. 

 
The Active Release Perspective in treating Carpal Tunnel Syndrome (CTS)

Active Release Technique (ART) is successful, where other traditional methods fail, because ART: Locates and removes the true, root cause of the problem – the adhesive restrictions that compress and constrain the median nerve, or other nerves, at multiple locations in the wrist, arm, shoulders, and neck.

ART recognizes and eliminates the causes of Pseudo-CTS. Pseudo-CTS shows similar signs and symptoms to traditional CTS, but its cause is due to nerve entrapments at locations other than the carpal tunnel, and for other nerves than just the median nerve. ART allows the practitioner to diagnose, find, and release multiple peripheral nerve entrapments along the entire kinetic chain – from the hand, to the shoulders, and into the neck.

Other techniques, particularly those using mechanical implements, can never reproduce the sensitivity or accuracy that ART can achieve. Basically, if you can’t feel the restriction, then you can’t find it, and you will miss the true cause of the problem.

ART is used to find the specific tissues that are restricted, and to physically work them back to their normal texture, tension, and length by using various hand positions and soft-tissue manipulation methods. When executed properly, the ART process treats the root cause of the injury by removing the restrictive adhesions that bind soft-tissues, and by allowing free movement of the nerve through the soft-tissues surrounding it. For example, when I perform these ART protocols, I can literally feel when the nerve entrapment has been released, and can often feel the nerve itself, as it moves through adjacent structures.

During a typical ART treatment, the practitioner:

Identifies both the primary and antagonistic muscles that are causing the injury. 
Locates the restrictive adhesions that have formed and the direction in which these adhesions are aligned. 
Determines which other structures are affected above and below the injury.
Uses the hands-on ART protocols to release the restrictions that are the cause of the problem.

Seems simple, doesn't it – and the results speak for themselves. Complete resolution for over 90% of the CTS cases that we have treated with ART and pilates rehabilitative exercises!

Review of the literature on Carpal Tunnel
This is my take on the article. Text in read is my opinion

Risk factors

Viibratory objects i.e. tools like drills, vacuums, saws, hair dryers, etc. 

Obesity (Obesity is often connected to an inflammatory state, Generally the tendons of the finger flexor muscles get inflamed and that squish the median nerve.

Monotonous wrist activity i.e. writing, typing, mousing, stirring. This is the big one because we often don't or are not able to stop an activity until too much damage has occurred.

Pregnancy 

Genetic heredity Either a small tunnel or an inflammatory predisposition.

Rheumatoid Arthritis

Menopause

Poor posture

Workload mismanagement

Kidney failure

Neck and shoulder problems

Hypothyroidism.

Use of oral contraceptives.

Congestive heart failure.  

Diabetes there is an inflammatory state. Even borderline glucose  above 90 or hemoglobin a1c above 5.7, Lipioc acid is helpful to heal nerves in Diabetes so this should be taken.

Alcoholism

Vitamin deficiency, especially B vitamins. 

Toxicity 

Exposure to toxins i.e from air, water, diet, etc.

 

Symptoms

Sensations i.e. pain, numbness, clumsy hands  may be felt in the thumb, index finger, middle finger and radial side(thumb side) of the ring finger.

Reduction in grip strength and hand function.

Muscles of the base of the thumb wasting way (the size of muscle at the base of thumb).

Prime aged between 40 and 60 years old but happens at all decades.

Women more than men.

Bending of the wrist in either flexion or extension makes the tunnel’s size smaller, so avoid that. The tunnel is largest at 15 degrees extension. We do an orthopedic test called Phallen’s that puts the wrist in extreme flexion and extension to provoke pain, confirm the diagnosis and to educate.

Stages of carpal tunnel syndrome

  • The first stage we wake up feeling of numbness and swelling in hand but no noticeable swelling.

  • Second stage development the occurrence of symptoms occur in the day such, symptoms occur when the patient engages in a repetitive activity involving the hand the wrist or if the maintain a   position for a long time. Patients may also have a feeling of  clumsiness,  weird gripping and dropping items.

  • Third stage of carpal tunnel syndrome development appears when there is hypotrophy or atrophy of muscle at the base of thumb. 

 

Management 

Splinting is low cost, safe and has a high yield

Corticosteroids be careful with this because of side effects and why not try both over the counter and natural anti-inflammatories. They are safer.

Physical Therapy 

Therapeutic ultrasound 

Yoga 

Carpal bone mobilization 

Nerve gliding exercises

Postural correction

 

Outlook

These forms of therapy and encourage improvements within two to six weeks with the maximum benefit felt at 3 months. Over 80% of the persons from carpal tunnel syndrome have a positive response to conservative treatment however there is an 80% chance of symptoms reoccurring in these patients within one year. This is because the irritations were not removed.

It is from this article and you can see my highlighted version here Received 03/12/2020

Carpal Tunnel Syndrome: A Review of Literature
Alessia Genova , Olivia Dix , Asem Saefan , Mala Thakur , Abbas Hassan

 

Common causes
  • Improper movement 

  • Abnormal biomechanics 

  • Imbalance muscles 

  • Previous trauma injury 

  • Repetitive micro trauma 

  • Adhesions/scar tissue of Gluteals, Hamstrings, Psoas, Para-spinals

  • Spinal misalignment/subluxation of the Lumbar spine and Pelvis

  • Tight muscles 

  • Acute trauma 

  • Overuse injury 

  • Poor posture 

  • Arthritis

Solutions