Article By: Dale J. Buchberger, PT, DC, CSCS, DACBSP
Carpal tunnel syndrome is one of the most common nerve entrapments of the upper extremity. It occurs when the median nerve is compressed in the wrist. However, it is not uncommon for compression of the median nerve to occur in several different sites in the forearm. Over the course of time, the general population has come to accept that hand and wrist pain, numbness, or tingling adds up to carpal tunnel syndrome. In fact, hundreds of people each year have wrist decompression surgery in hopes of relieving these symptoms. The problem with this thought process is that there are many causes of numbness, tingling, and/or pain in the hands and fingers.
Symptoms specific to carpal tunnel syndrome most often occur in the thumb, index finger, middle finger, and half of the ring finger. If you have symptoms in your fingers but your little finger is fine, this may be a sign that you have carpal tunnel syndrome. There are two other peripheral nerves that supply the hand. The ulnar nerve supplies the little finger, while the radial nerve supplies the backside of the thumb, index and middle fingers. Nerve roots from the neck or cervical spine (C6, C7, C8) control a different pattern of sensation in the hand with some overlap. This is what makes the diagnosis of a cervical spine problem versus true carpal tunnel syndrome so challenging. It is also why it is so important to answer questions about your symptoms as specifically as possible. The diagnosis will sway one way or another based on the answers you provide.
Many people who have undergone surgery for carpal tunnel syndrome continue to experience hand, wrist, and arm pain or tingling. There are some that get temporary relief but the problem recurs frequently with symptoms of higher intensity. Other patients develop symptoms similar to carpal tunnel syndrome following neck injury. They may not have had a wrist injury but still experience pain in the hand.
Since the body is a complex network of joints, nerves, ligaments, muscle and fascia, it is possible that a symptom from one area of the body may be caused by a problem located in a different part of the body. This approach to healing is more holistic as opposed to the isolationist approach. Recent research demonstrates this to be the case in patients experiencing symptoms of carpal tunnel syndrome. Some studies indicate that it is not uncommon for symptoms of carpal tunnel syndrome may be caused by muscle stiffness in the neck and shoulders, resulting in poor posture, tense muscles, nerve compression and pain traveling down the arm and into the hand.
While we have created a technologically advanced society, these advancements have accelerated the aging process creating chronic postural distortions in even our youngest members. Previous articles in this column were focused on “iPosture” and the “effects of sitting”. I would recommend that you read these to complete this articles content. In a given day it is not uncommon for the majority of the population to go from a car, to a desk and computer, back to a car, and finally a La-Z-Boy.
This lack of movement creates a domino effect, and most relevant to carpal tunnel syndrome is the rounding of the shoulders and forward head posture. When the shoulders round, and the head shifts forward, the muscles in the neck and shoulders compress the nerves that course from the neck to the hand. The hand requires a stable base at the neck and shoulders in order to function properly. Weakness caused by inactivity and poor posture ultimately causes the hand and forearm muscles to be over worked. This results in “double crush syndrome” or nerve compression in the neck and shoulders proximally while also causing compression distally in the hand and forearm. This results in tingling, pain or numbness in the hand, wrist and arm.
Before you accept a diagnosis of carpal tunnel syndrome, ask yourself some simple questions. Did anyone examine my neck? Was I given an explanation why my neck was not a cause of my hand symptoms? Should I get a second opinion? Does the diagnosis of carpal tunnel syndrome make sense? Were metabolic causes of carpal tunnel syndrome ruled out; things such as diabetes, thyroid disease, and even pregnancy?
Generally speaking, there are many options for the treatment of patients experiencing carpal tunnel like symptoms. Do your homework and work with healthcare providers that share your goals and expectations. As the patient, it is your right to choose a physical therapist with whom you feel most comfortable discussing all aspects of your care.