Carpal tunnel syndrome is a very common condition that can effects the thumb and first few fingers of the hand. Hand numbness, tingling, pins/needles, or other sensations are common symptoms of carpal tunnel syndrome. Weakness in hand strength, finger coordination, or difficulty performing repetitive motions for a prolonged period of time are common results of compression of the median nerve.
Risk factors for developing carpal tunnel are repetitive motions, especially with some level of strength or force required. It is more common in hitting sports like tennis and racquetball. However, repetitive motions like knitting or sewing increase the likelihood of developing it also. Any activity that involves prolonged vibration can also increase the likelihood of developing carpal tunnel syndrome.
This nerve travels from the spine down the arm and into the
hand. At several locations it can become "compressed
or pinched." A nerve entrapment is when something is
causing compression on the nerve, resulting in decreased nerve
function. Prolonged compressions or entrapments can eventually
cause damage to the nerves.
Everyone has hit their elbow and felt the "funny bone tingling" in their hand. Striking the funny bone is an example of a sudden compression of the nerve resulting in hand tingling. Even through the compression was at the elbow you feel it in the hand. The funny bone is actually the ulnar nerve which travels and innervates the little fingers of the hand.
Not all compressions are as dramatic as hitting your elbow. Most are more subtle, such as muscles slowly tightening and spasming over time. When muscles are overworked they begin to tighten and shorten, potentially leading to compression on the nerves. An example of this is the pronator teres muscle in the forearm. When the muscle spasms it may compress the median nerve, producing the symptoms of carpal tunnel.
With compression of the median nerve at the elbow, the person will feel hand pain and tingling. The common evaluation tests will show carpal tunnel symptoms. But additional tests will be needed to determine exactly where the entrapment is coming from. In addition, many people have two small nerve entrapments leading to the hand pain.
A double crush syndrome is the term for multiple entrapments of a nerve producing the intensity of the syndrome. Two mild compressions of the nerve lead to significant impairment. Treating only one of the areas improves the numbness, tingling, or muscle weakness. However, the symptoms are likely to return when the person returns to normal activities. Both areas should be addressed for proper recovery.
The double crush syndrome may be the problem with people who initially showed improvement after surgery but then regressed within several months. Surgery did relieve the swelling and irritation of the carpal tunnel at the wrist, but may not have addressed other nerve entrapments.
With the potential of a double crush, it is important to evaluate all potential entrapments sites when someone complains of pain, numbness, tingling, weakness, or lack of coordination in their hands.
After identifying the nerve entrapment site, the next step is to decrease the swelling around the entrapment sites. Common therapies for decreasing the swelling are ice, electric therapy, stretching, light exercises, massage, bracing, taping, and other physical therapy modalities. Cold Laser is becoming a more common treatment for carpal tunnel. Cold lasers stimulate the cells to increase certain enzymes or cellular activities. The lasers stimulate the cells to open blood vessels, increase cellular energy production and lymphatic drainage, decrease inflammation, and speed up tissue repair. Laser therapy is painless and gentle. It can be used along the median nerves path to stimulate and speed its recovery.
Average laser treatment protocols for moderate carpal tunnel symptoms are 6-10 treatments over a few weeks. Stronger Class IV lasers are required for treating large areas such as the median nerve. In 10-15 minutes 3,000-5000 Joules of energy may be required. Older class III lasers cannot produce the energy needed for treatment. Treatment is most effective when it combines laser therapy with other known treatment therapies.
More information on lasers can be found at Laser Treatment Info .
Perry Nickelston wrote an interesting article on posture and carpal tunnel syndrome. He has noticed people with slouching forward and rounded postures may increase the amount of functional stress on the arms and shoulders during normal movements. The slouching forward posture increases the muscle spasms of the chest and pectoralis minor muscle, pulling the shoulders more forward. In this position the kinetic chain is disrupted potentially restricting the normal fascial chains and movements. This would place more stress on certain muscles, tendons, ligaments, and joints; potentially increasing the likelihood of repetitive motion, swelling, and inflammation.
This may contribute to the increased risk of developing carpal tunnel from prolonged computer work. It would also indicate why patient's report their hand symptoms are less when they consciously focus on working with good posture. Sitting with proper posture decreases the physical stress and workload on the elbow, forearm, and wrist muscles and joints.
In conclusion, sit up straight. Decrease the force, repetitions, vibration, and amount of activity you place on your arms and hands. Decrease the muscle spasms, inflammation, edema, and entrapment locations on the median nerve. It is easier said that done. It usually is a process with ups and downs, but improvement can be made.