Massage Therapy, Cranial Sacral Therapy and Reiki

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Understanding Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is a condition resulting from a reduction in the size of the carpal tunnel, causing pressure on the median nerve running through the wrist.  The carpal tunnel, formed by eight carpal bones and the transverse carpal ligament, services as a pathway for the median nerve, which provides sensation to the thumb, index, middle and half of the ring fingers.  The tunnel also contains flexor tendons which control finger movement.  Anything that causes swelling, thickening or irritation in this area can reduce the pathway, pinching the nerve and affecting the function of the flexor tendons.

Symptoms and diagnosis

Initial warning signs of CTS are numbness and tingling in the fingers, especially at night, and a felling of tightness in the fingers with no visible swelling.  These symptoms are sometimes dismissed by the sufferer if they resolve with rest.  But when the hands are put back into action, the symptoms will reappear.  If not caught at this early stage, the condition goes on to produce finger tingling during the day, loss of grip strength, tingling in the palm area and severe pain in the wrist and hand.  With further deterioration, the pain shoots from the hand up to the arm as far as the shoulder.  The person experiences clumsiness in fine motor coordination and is prone to dropping things.  Some report an inability to discern hot from cold by touch.  In the advanced stage, permanent nerve damage and atrophy of the thenar muscle at the base of the thumb can occur.

Restriction of the carpal tunnel can result from many factors but the most predominant in our culture is repetitive strain.  Affecting millions of people, CTS is sometimes referred to as an epidemic of the computer age, commonly affecting keyboard users.  The repetitive flexing and extension of the wrist results in thickening of the protective sheaths surrounding each of the tendons, increasing pressure on the nerve and producing pain with each movement.  Gripping and pinching movements, overwork of muscles of the arm and use of vibrating tools are also known to contribute to development of CTS.

The focus on job specialization in recent years has produced a number of occupations in which the same few hand manipulations are required over and over.  Repetitive strains of the wrist are more common in women than men, but those most at risk comprise a wide spectrum of occupations:  massage therapists, musicians, computer users, construction, assembly line workers, hair stylists, mechanics, farm and factory workers, and meat, fish and poultry workers.

Specific medical conditions are not to be overlooked when evaluating wrist pain, so it's important to check with a client's doctor about the diagnosis.  Edema sometimes results from hormonal changes which cause fluid retention in pregnancy, premenstrual syndrome and menopause.  Rheumatoid arthritis, hyperthyroidism, diabetes mellitus, and other systemic conditions, as well as neck and shoulder injuries, thoracic outlet syndrome and ligament sprains, can produce the same symptoms as CTS.  

Physician diagnosis is determined by nerve conduction test of physical exams which reproduce symptoms.  Phalen's test for wrist flexion involves placing the back of the hands together in a bent position.  The test is positive if numbness, tingling or pain is experience within one minute.  A median nerve percussion test, Tinel sigh, is also used to elicit numbness or tingling by tapping the median nerve at the wrist on the palm side.

Treatment approaches

Traditional medical treatment for CTS calls for a splint or brace to minimize movement that would put pressure on the nerve, modification of repetitive movement, corticosteroid injections or medications to reduce swelling, and finally, if these methods fail, surgical intervention.  The success rate with these methods is minuscule and the process of treatment is long and tedious. There can be complications from surgical intervention, such as a weakened grip and loss in finger sensation, and symptoms are likely to reappear within a few years.

Soft tissue release has been one of the most successful techniques applied by massage therapists to treat CTS.  Renowned practitioners such as Stuart Taws, Michael Young and David Weinstock report complete relief of symptoms in one to three sessions.  Weinstock also follows up soft tissue release with neuromuscular reprogramming.  Young points out that what most treatment approaches overlook is that overuse of the forearm causes the muscle to become tighter and tighter, restricting circulation to the lower part of the arm.  When blood flow to this area is restricted, swelling occurs and oxygen supply to the median nerve is decreased.  By releasing the muscles farther up, from the wrist to elbow, proper circulation is reestablished.  Following initial treatment session, clients are typically given instructions for self-care exercising at home to maintain stretching and proper movement.

Nutritional intervention has been noted as an aide in reduction of the edema of CTS.  Clinical studies have shown that vitamin B6 supplements, which have diuretic properties, reduced or eliminated symptoms in up to 50% of participants.  Increasing water intake is also encouraged to reduce fluid retention.  For some types of CTS, acupuncture has been successful in improving nerve conduction.  

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