Carpal Tunnel Syndrome

          To understand how things go wrong in the body, we first have to know how it should work. The anatomy of the wrist and arm is key to understanding the causes of Carpal Tunnel.

         In the picture below you can see how many of the muscles that help us move our fingers are actually up in the forearm with long tendons that run down into the hand. You can place the fingers of your right hand on the knobby parts of the elbows (epicondyles). Now, with your left hand, make a fist, relax your hand, flex and extend your left wrist. You can feel the muscles bunching under your right hand. In the picture on the left (the anterior view), you can see the median nerve labeled up by the elbow. This nerve also runs down the forearm into the palm of the hand. The compression of this nerve is what causes the numbness, tingling, and pain associated with carpal tunnel syndrome. 

         So what exactly IS the carpal tunnel?    

The hamate,pisiform, lunate, capitate, trapezoid, an scaphoid make up the "carpal" bones. The carpal tunnel is a narrow passage made up by these bones. The nine tendons of the flexor muscles (the ones used to make a fist and curl the hand inward), and the median nerve all pass through the tunnel. There is also a structure called the flexor retinaculum. This is strong band of connective tissue that wraps around the wrist. It helps to keep tendons in place and provide stability to the wrist. 

        Carpal Tunnel Syndrome is one of many RSI or Repetitive Strain Injury. RSI occur when a particular movement is performed over and over again and places undue strain on a particular structure. The body is a mechanical structure. Just like a machine, if the muscles or tendons are under constant strain, eventually something will give. If you have a pulley system and the rope is constantly being run through the pulley, eventually that spot on the rope will begin to fray. 

          Inflammation of the area creates compression on the median nerve. Inflammation can be caused by constant strain and pressure on the tendons. This strain can happen from doing the same motion over and over again. Using a mouse, typing on a computer, knitting, or performing sign language are just a few examples. Tendons are covered in a protective sheath. When there is constant strain this sheath can be worn away. It is similar to the covering of electrical wires. When the live wires come into contact with each other you get sparks. When the sheaths wear away the tendon becomes inflamed. Inflammation is part of the bodies healing process.

          The problem is that there is very little space in the tunnel. When the area becomes inflamed there is nowhere for anything to go, and you get pressure of the median nerve.

          Compression of this nerve can cause pain, tingling, numbness in the thumb, first two fingers, and up the arm.

           One further complexity is that certain trigger points present in the shoulder and upper arm can mimic carpal tunnel symptoms. These trigger points can present as pain down the arm, numbness in the hand and fingers, or tingling in the arm and hand.       

           If you have true carpal tunnel syndrome what can be done? It partially depends on the severity of your syndrome. If you are in the beginning stages massage, chiropractics, and exercises can help to reduce the symptoms. These therapies can also help prevent carpal tunnel from becoming an issue in the first place. If your tissues are healthy and supple the chances of injury are much lower. Sadly, a lot of the medical sites I've looked at omit massage from being a viable option.  

          One thing to keep in mind, if you choose massage to help reduce symptoms. Massage takes time. One session rarely "fixes" the problem. This doesn't mean you won't feel better. It just might take more than one session to address all the issues that combine to create the dysfunction. Also, to get the best out of your session, doing stretches and exercises at home will help maintain the work done during the massage.           If you have questions or concerns about getting massage: talk to a doctor to see if massage is acceptable. You can also call the therapist and ask what sort of approach they would take.