Carpal Tunnel Syndrome
Carpal tunnel syndrome is a condition that affects more and more people today. It is especially prevalent among people that spend a lot of time on the computer and can make work stressful. It is treatable and its treatment will be discussed in further articles.
The Carpal Tunnel
The carpal tunnel of the wrist is made up of all the carpal or wrist bones which form an arch over the tunnel. On the other side is the flexor retinaculum, a strip of fascia which forms the floor of the arch, securing either end of the arch. The 2 components form a tunnel that allows nerves and blood vessels through. Of particular importance is the median nerve which passes through the tunnel and supplies the thumb, index finger, middle finger, and half the ring finger with nerve impulses. At rest, the pressure inside a healthy carpal tunnel is 2.5 mm Hg. When there is carpal tunnel syndrome, the pressure inside the tunnel is more than ten times the normal amount: 32 mm Hg.
Causes of Carpal Tunnel Syndrome
This extra pressure compresses or pinches the median nerve affecting the functioning of the fingers it supplies. These fingers might feel tingling, numbness or in extreme cases, weakness.
Approximately 1% of the population suffer from carpal tunnel syndrome, but numbers are rising. There is a genetic component to it, but the majority of people suffering from carpal tunnel syndrome get it from repetitive motions at work. Occupations that involve lots of repetitive motions with the hands have higher incidences of carpal tunnel syndrome:
- keyboard operators
- assembly line workers
- massage therapists (yikes!!!)
- cigar makers
Carpal tunnel syndrome may also arise from:
- diabetes (14% of carpal tunnel syndrome also suffer from diabetes)
- other nerve impingements
- motor vehicle or other accidents
- premenstrual, pregnancy, menopause
Symptoms of Carpal Tunnel Syndrome:
- Tingling or numbness in the hand especially in the thumb, index, middle and half the ring finger
- wrist pain
- pain in forearm or elbow
- usually in the dominant hand (left/right handed)
- increased symptoms while sleeping
- decreased range of motion of the wrist
- swelling in the wrist or hand
- Compression of the tunnel,
My experience with symptoms commonly associated with carpal tunnel is that there is usually rsi damage to the extensors of the fingers and wrist, and this is easily diagnosed when direct pressure to those muscles results in pain, sensory or motor neuron indications. Referred pain is common, but if direct pressure on the carpal tunnel doesn’t result in pain in the exact spot, you will need to look for an alternate cause other than carpal tunnel.
Ken Shim, RMT
Thanks for writing Greg. You are absolutely right. Carpal tunnel syndrome is over diagnosed far too often. It is not uncommon to meet a client who has been diagnosed with carpal tunnel syndrome but who tests negatively with a phalen’s test, reverse phalen’s test, pressure or irritation on the tunnel. Meaning they don’t have a clinical representation of carpal tunnel syndrome. Meanwhile, they instead test positive for pronator teres syndrome or thoracic outlet syndrome. Proper testing is key to finding the best treatment