Is it REALLY Carpal Tunnel Syndrome?
By Kelly Fisher, OTR/L
What is Carpal Tunnel Syndrome?
Simply speaking, Carpal Tunnel Syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist. This is a well known condition that is one of the most commonly treated problems by hand therapists. The most common symptoms of Carpal Tunnel Syndrome (CTS) include numbness, tingling and sometimes pain within the palm side of the thumb, index, middle and a partial area of the ring finger.
CTS is one of multiple nerve compression injuries that can cause these symptoms and often patients experiencing numbness and tingling have a difficult time differentiating which fingers are affected. In many cases it can feel like the entire hand is numb, and can occur during inconsistent timeframes and activities. Although CTS is the most common diagnosis associated with these symptoms, it is a compression injury of only one particular nerve at one specific location, the wrist.
We have three different nerves that begin at the spinal cord in our neck and travel down through our shoulder and arms to provide sensation and muscle control to three different areas in the hands. The pathways for each nerve travel through many tunnels and canals made up of either bones or soft tissues, such as muscle, and each one can be “compressed”, squeezed or pinched at any one of the four most common areas. These include: the neck, shoulder, elbow and the wrist.
Any combination of one or more nerves being compressed at one or more of these locations can cause numbness and tingling in the fingers. This is why CTS can often be incorrectly diagnosed and treatments performed just to the carpal tunnel can be ineffective. It is important to understand that nerve compressions can occur at more than one location at a time. This is called a “Double-Crush” injury. What is critical to understand is the unique response that nerve tissue has to irritation. A small compression in one spot on the nerve can result in no symptoms at all, while the same small pressure in two or more locations can result in a very painful condition. It’s important for treatment to be implemented at each affected area in order to get the best result.
Often nerve compression injuries, regardless of location and nerve involved can be treated successfully, and without surgery. This is especially true if evaluation and treatment is performed earlier on from the onset of symptoms. However, even if a patient has been experiencing long-term symptoms, conservative treatment may still be successful. Some of the most common and correctable causes of nerve compression injuries from the neck down include: rounded back and forward shoulder posturing from work or other daily tasks, prolonged forward reaching positions such as with mouse use or machine operation, increased contact pressure to the wrists or elbows such as with keyboarding, poorly positioned arm rests, prolonged or repeated exposure to even low-level vibration, or repetitive or sustained gripping/pinching activities.
Know that when symptoms are mild, that is the time that they are most easily treated, and when you have the best opportunity to prevent a more serious condition. Regardless of where the symptoms are coming from, they have the potential to get worse and become a more chronic nerve compression and can lead to permanent nerve damage. A skilled Occupational or Physical Therapist is trained to evaluate and treat all of these potential compression sites. At that time they can provide education on preventative exercise and positioning to decrease the risk of symptoms returning in the future. A therapist works closely with physicians and will collaborate with your doctor if the evaluation reveals a more serious issue or potential underlying medical condition.