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Taking The Confusion Out Of Carpal Tunnel Syndrome

Wrist pain and numbness in the fingers are common symptoms. Often, the carpal tunnel takes the wrap.

This is because the term carpal tunnel syndrome is so well known, being experienced by roughly 5% of the population. As a result, many apply themselves this label and purchase wrist braces, support devices or new computer accessories to reduce symptoms. However, there are many disorders of the neck, arm and hand that produce similar symptoms, sometimes resulting in the wrong area getting all the attention. In fact, only 1 in 5 people with these symptoms are experiencing a true carpal tunnel syndrome.

To understand the syndrome a little better, the best place to start is the anatomy. The carpal tunnel is a small canal formed by tiny bones in the wrist (called carpals) and surrounding soft-tissues which serve to protect a major nerve to the hand and a group of tendons traveling from the forearm. Normally, this tunnel has ample room for the contents to move and exist in peace. However, these structures (particularly the nerve) can become susceptible to compression during times of swelling, acute injury and inflammation or from the tissue changes created by repetitive strain. Inevitably this results in pain, numbness and tingling of the thumb and first two fingers as well as weakness within specific muscles of the hand.

But wrist pain does not automatically mean carpal tunnel syndrome. There are muscles in the shoulder and elbow that can cause referred pain to the wrist, hand and fingers. Inflamed joints or a pinched nerve in the neck can cause hand pain and numbness. There are even other points along the arm where a nerve can be compressed and feel very similar to carpal tunnel syndrome. This is why receiving an accurate diagnosis, which identifies the cause of symptoms, is so vital to treatment success.

In fact, the major nerve passing through the carpal tunnel can be pinched in at least eight locations as it travels from the neck to the hand, with the carpel tunnel being at the far end of this list. There are also three other major nerves which travel down the arm, each with their own list of impingement sites, that can create pain and numbness in the wrist and hand. This is why some people can experience symptoms for a very long time, with little relief from wrist supports, braces, therapeutic modalities such as ultrasound or laser therapy, medications or even surgery. After all, if the treatment is delivered to the wrist, and the problem actually starts in the shoulder…it is no wonder the problem will persist.

Most often, a clinical examination which evaluates for strength and flexibility imbalances, muscle dysfunction and tissue adhesions from repetitive strain, normal joint mechanics as well as all possible sites of nerve compression, will differentiate a true carpal tunnel syndrome from another disorder of the joints and tissues. Other tests such as nerve conduction studies are also be very helpful in identifying nerve compression at the carpal tunnel.

For a true carpal tunnel syndrome, there are many treatments that can offer relief to those burdened. While surgery will often come to the front of one’s mind, this is typically reserved as a last resort. In fact, current research supports the use of manual therapy to restore normal movement to the elbow, hand and wrist. This could include Active Release Techniques (ART), clinical acupuncture, functional dry needling, joint mobilization/manipulation and nerve flossing. These techniques in conjunction with exercise, ice-therapy and activity modification are likely to achieve the best results.

As with most musculoskeletal injuries, the first step in treatment is identifying the true cause of the symptoms, which also includes problem solving the functional strains and deficits which allowed them to develop in the first place.

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