Carpal Tunnel Syndrome (CTS)

• Overview
• Symptoms
• Onset
• At risk behavior and activities

• Scalene muscles
• Infraspinatus/supraspinatus
• Triceps brachii
• Forearm flexors/extensor

• Scalenes
• Infraspinatus/supraspinatus
• Triceps brachii
• Forearm flexors/extensors
  

Overview

Carpal Tunnel Syndrome can be a very debilitating condition involving numbness, tingling and burning of the hand with pain shooting up or down the arm.

This overview is designed to help give you a comprehensive understanding of what causes these symptoms as well as empower you to begin managing the condition yourself. Remember, this information is not intended to treat, diagnose, or cure any disease nor is it a substitute for advice from a qualified health professional.

Symptoms

Numbness, tingling and burning of the hand, particularly in the index, middle, and the adjacent half of the ring finger are the most common symptoms related to CTS. Note these symptoms are not found in the pinky finger. If you are experiencing symptoms in the little finger, there is most likely another cause for the condition other than CTS. Pain may be felt in the hand as well as radiating up the arm and into the elbow and shoulder. Pain may also be felt radiating down the arm and into the hand. Grip weakness and dropped objects are another complaint of sufferers of CTS. People tend to drop objects due to a lack of grip or failed grip. A decrease of sweating may be another cause of dropped objects since dry skin has less friction and allows the object to slip from the hand.

Note: The primary Sx of CTS are the numbness along with burning and tingling as mentioned above. Pain in any area without numbness and tingling is most likely not CTS.

Onset

CTS many times begin while a person is sleeping due to the fact that most people sleep with their wrists in the flexed position, which further compresses the median nerve, thus inducing symptoms.

At Risk Behaviors and Activities

Since there are many different types of work and activities which may induce CTS, we may not be able to list them all. It is important to take inventory of your daily life activities to determine if you are at a higher risk for this condition. Activities which involve the following movements have been shown to place people at higher risk for developing CTS.

• Repetitive motion of the hands and wrists.
• Working with the hands and wrists which involve cupping or bringing the thumb and pinky finger together (electrical work and sewing)

CTS Events as related to Occupations as published by the Bureau of Labor Statistics in 20023

• Assemblers
• Cashiers
• Secretaries
• General office clerks
• Laborers, non-construction
• Bookkeepers, accounting, and auditing clerks
• Welders and cutters
• Data-entry employees
• Textile sewing machine operators
• Order clerks
• Supervisors and proprietors, sales occupations
• Machine operators (unspecified)
• Truck drivers
• Investigators and adjusters (i.e., insurance)
• Insurance adjusters, examiners, and investigators
• Electrical and electronic equipment assemblers
• Packaging and filling machine operators
• janitors and cleaners
• Bank tellers
• Production inspectors, checkers, and examiners

Non specific activities which pose high risk for development of CTS

Computer users and typists are at risk for developing CTS due to repetitive typing and key entry although strong evidence to support this statement is lacking. Some studies do show a correlation between fast typing (more than 60 words per minute) and harder key strokes. Another study shows that mouse users have a higher incidence yet.

The above statement relates to diagnosis of CTS through nerve conduction tests. Keep in mind there are other conditions that involve the muscles which may cause these symptoms. If so, nerve conduction tests will not be positive for CTS, but if symptoms are present and testing does not indicate CTS, then treatment of the muscular system should be very beneficial.

Airplane assemblers, meat packers, and those in the fish industry have some of the highest risk for developing CTS, which one study has shown to be around 15%. Complaints of the condition in the meat packing industry go back as far as the 1860’s⁴

Musicians have a very high risk as well. One study shows that 20% of musicians complain of problems related to the muscles and nerves of the hands neck and shoulders.

Home workers who do extensive cooking, sewing, needlepoint, computer/video games, wood working, or use power tools also have a high incidence of developing CTS.

Gender influence

According to the National Institutes of Health, women are three times more likely to suffer CTS. Although there is little evidence to support the reason why this is true, there are studies that show the correlation between hormonal events in women and CTS, such as:

• During pregnancy where 11% reported CTS. Only 4% remained symptomatic one year after delivery.
• Menopause
• During breast feeding.

Other physical characteristics which have been linked to higher prevalence of Carpal Tunnel

• Obesity
• Square wrists (where the width and thickness are the same)
• Shorter and wider than average palm shape and shorter third fingers are more likely to develop CTS
• Poor upper back strength due to weak muscles which do not allow for proper posture thus placing more forces on         the arms and influencing the development of CTS.

Identifying the Muscular Components of CTS

Let us first look at how the muscles of the body can cause pain and dysfunction. According to specialists in the field of myofascial pain, there are 4 major causes of pain from the muscular system.

Muscle tension comes from not working off the stresses of life and is one of the most common reason for chronic pain. Because the muscles are staying tighter than normal the muscles actually begin to cut off their own circulation and place additional pressure on surrounding nerves and eventually irritating them.

Muscle spasm is when a muscle contracts strongly and won’t let go. This is what is usually responsible when a person says their “back went out”.

Muscle weakness is a part of both muscular tension and spasm. Underexercised muscles may contribute to much, if not all, of pain supposedly caused by arthritis.5

Muscle trigger points are small tender nodes of degenerated muscle tissue which develop as a result of prolonged spasm or tension and have the ability to send pain to areas distant to their location. Theses trigger points need to be addressed first as any type of strengthening tends to make pain from trigger points worsen.

Assessing yourself and applying self treatment

I would first like to say, as a therapist, any person who is attempting to run this protocol without at least consulting a professional who is familiar with muscle syndromes is taking somewhat of a risk of misdiagnosing themselves. Notable therapists will help you learn to treat yourself properly and once you understand what needs to be done, you will be able to apply self treatment during flare ups down the road and circumvent therapy since you won’t need it. We advise to interview potential doctors and therapists to be sure they will not make you a “professional patient”. One of the only things worse than being in chronic pain is being a chronic pain patient!

Assess your muscles for tenderness and tightness

The muscles which cause pain in the hand can be found in the neck, chest, shoulders, and forearms. If you feel any tightness in these areas or if you feel like pain is radiating then you may have trigger points causing your pain. Below are a group of pictures of referred pain from trigger points that may be likely
to cause your condition.

Scalene It is important to realize that if there is pain in your shoulder blade and down your arm as well as in your hand, that it may all be from one source – trigger points in the scalene muscle (image 1). These muscles, although difficult to palpate, can be treated at home using your fingers to palpate and moist heat to then relax the muscles.

Infraspinatus & Supraspinatus There are a couple other muscles which refer into the arm, forearm, and hand. These muscles are part of the rotator cuff of the shoulder and are called infraspinatus and supraspinatus (image 2). Trigger points in these muscles, which are very frequent, can also cause other trigger points to form in the forearm, which will project pain into the hand! This is usually what occurs if the condition has been present for some time and accounts for those who say the problem began somewhere in their shoulder and eventually went into the forearm and hand. Location of these muscles is on the backside of the shoulder blade (scapula) above and below the somewhat diagonal spine of the scapula. If you reach over your shoulder using the opposite hand, the bone you feel running perpendicular to the vertebrae is the spine of the scapula. Other than using a self treatment tool, such as the Backnobber II, you may use a tennis ball in a sock. Use the sock to dangle the tennis ball down between the wall and the scapula and lean back against the ball. You should use the opposite arm to hold the tennis ball from the side you are treating.

Extensors of the forearm and wrist The extensors of the forearm and wrist are almost always involved, but the reason we list them last is because we know that if you only treat them without looking at the other muscles listed above, you will most likely not get the relief you are looking for, especially in chronic cases. Because there are so many muscles in the forearm we recommend referring to your workbook and treating the extensors and flexors in a ‘global’ fashion by treating them in groups using a Jacknobber II, Knobble II, or lacrosse or tennis ball.

Stretches for the arm, forearm, and hand

General Stretching Instructions

• Always stretch in a pain free range of motion
• Hold the stretch 3-5 seconds
• Coordinate breathing with stretches - exhale during stretch
• Do 2-3 repetitions of each stretch.
• REPEAT every 1 to 1.5 hours for the first few days

Conclusion

Although your nerve conduction test indicates CTS, a conservative approach, such as this one may prove beneficial to your condition. Always consult your physician to be sure this approach is safe for you. If surgery is being pushed by the physician and you are not sure, remember – this is why there are second opinions!

We wish you all the best and truly hope you find some relief, if not total pain elimination, from this paper.