Carpal tunnel
What Is Carpal Tunnel?
The definition of carpal tunnel syndrome is compression of your median nerve as it passes through the carpal tunnel. Let’s break that down. Your carpal tunnel is the space between your wrist bones and the ligament (called the transverse ligament) that runs across the top of it. This forms an oval shape that encloses your flexor muscles- muscles that flex your fingers so you can grab objects, like your coffee cup in the morning- your median nerve. The median nerve is especially important for normal hand functioning as it has motor and sensory functions in the palm side of the thumb, pointer middle and half the ring finger.
What happens when the Carpal Tunnel space closes down?
When this space becomes compressed you get pinching and pressure on these tendons and the median nerve which can cause pain, tingling and muscle weakness of this area. It can feel like pins and needles, swollen fingers, burning sensations or just general aching pain. It is commonly worse at night and can wake you up. A common movement for people with carpal tunnel is flicking their wrist and trying to shake out those feeling to get feeling back in the hand.
Common causes of Carpal Tunnel Syndrome:
Small repetitive movements of the hand such as typing on a computer or your phone as well as repetitive grasping movements like holding onto a paint brush or gardening are common causes of Carpal Tunnel syndrome. Other causes can be inflammatory conditions like rheumatoid arthritis, metabolic changes such as thyroid imbalance or injuries such as sprains and strains of the wrist causing inflammation. As you can imagine with the carpal bones being the floor and a ligament being the roof of the carpal tunnel space, it is a very rigid space. This means that any change in inflammation, swelling or compression of that space can cause issues.
How do we diagnose carpal tunnel syndrome?
The most important thing is proper diagnosis!! We assess this area thoroughly with visualization, orthopedic and neurologic tests as several conditions can be very similar to carpal tunnel.
First we need to look at the area. This sounds simple and basic but there's an important sign we need to watch for in Carpal Tunnel Syndrome called thenar wasting. The thenar area is your thumb pad region. The muscles of your thumb are able to work due to signals from your median nerve. In chronic carpal tunnel we will see this area begin to shrink and those muscles atrophy as the median nerve’s signal is blocked and no longer can tell these muscles to function. Having a good doctor look at your hands and diagnose this early can be very important to treatment.
Next, we do our orthopedic exams, which includes moving the wrist in different directions trying to elicit the pain and tingling that you’re feeling, which can help us to diagnose carpal tunnel. The last step in evaluation is neurologic tests to make sure that median nerve is still firing signals to the sensory and motor systems. This means that we check your feeling in both hands and then motor function in your finger flexors. This assesses any motor or sensory deficiencies from the pinching of the median nerve and help us to accurately diagnose carpal tunnel.
How Do We Treat Carpal Tunnel Syndrome?
A therapy we have had great success with is called Graston therapy or Instrument Assisted Soft Tissue treatment. What this does is stretch the oval space of the carpal tunnel and break down any scar tissue or muscle adhesions in that area. This allows for the median nerve to have the space to properly send signals to the skin and muscles. We will also adjust the wrist bones. As the carpal (wrist) bones are the bottom floor of the oval in the carpal tunnel, we want to assess and adjust them as needed to improve movement. This is done through specific and gentle adjustments of the joints.
Another aspect of carpal tunnel syndrome we like to assess in office is nutrition. This is because if you have more fluid retention or inflammation in your body, it can compress the carpal tunnel space and cause symptoms. This is also why carpal tunnel can be present during pregnancy as you have more fluid retention in your body.
While treating this condition we commonly recommend braces at night time if pain has woken you up before as it neutralizes the wrist and does not allow for compression at night.
Why Proper Diagnosis of Carpal Tunnel is Critical!
Many conditions have similar symptoms to carpal tunnel and if your Doctor is not treating the true cause of your pain/symptoms you could have a wrong diagnosis and your condition could get worse. Below are 3 similar conditions:
Thoracic outlet syndrome (TOS) is caused by compression of vasculature and/or nerves by the collarbone, ribs or tight muscles in your neck called scalenes. This can cause pain, tingling or muscle weakness in the arm, hand or fingers.
Compression of the median nerve. The median nerve can be impinged in your elbow and forearm which can cause the same symptoms as carpal tunnel- tingling, pain, numbness or muscle weakness.
Pinched nerve in your neck – This can also cause pain, tingling or muscle weakness down the arm. This is commonly in more specific patterns depending on what nerve root is compressed in the neck. For example, the nerve root C6 which is a nerve that comes out of the spine closer to the bottom of the neck. C6, when pinched, can cause symptoms of pain, tingling or muscle weakness on the the outside of the forearm, thumb and pointer finger. Again, similar to carpal tunnel syndrome symptoms.
The common difference between these 3 conditions and true carpal tunnel is that these all have forearm or upper arm symptoms associated with it. If you are having forearm and hand pain, it is likely not true carpal tunnel.
Get a true diagnosis, get treated and get on with your life! We all want get back to doing what we love if that includes gardening, weight lifting, painting or just doing work on our computers without pain! If you are feeling these symptoms and want an evaluation, give us a call at 717-999-4347 or book online to schedule your appointment today!
Harrisburg Joint & Muscle in Lemoyne has all the tools to get you out of pain!
