Definition:
Carpal Tunnel – a channel in the wrist surrounded by the 8 carpus bones and the transverse carpal ligament.
Nine flexor tendons and the median nerve (supplying sensation to the thumb and first three fingers of the hand) pass through the tunnel.
Carpal Tunnel Syndrome – entrapment or compression of the median nerve

Causes: constant flexion and extension of the wrist causing irritation of the tendons which leads to inflammation and pressure on the median nerve.
-misalignment of the wrist and carpal bones causing irritation, inflammation
-acute trauma to the wrist such as fracture of tenosynovitis
-gout
-arthritic conditions
-tumors
-pregnancy
-diabetes mellitus
-hypothyroidism –
–aspartame reaction
-Neck and Shoulder Problems are the most common cause of wrist pain.
Signs/Symptoms: tingling, burning, pins and needles feelings, weakness in the thumb and first three fingers; pain may occur in the wrist radiating up the arm.  Extreme cases can cause loss of grip strength, muscle atrophy and constant wrist pain in which the client will drop things.

Tests:

1. tap the inside of the wrist to se if there is a tingling sensation in the fingertips or hand
2. bend the wrist downward with the thumb and forefinger touching for one minute -pain may indicate CTS
3. Nerve conduction test should be done to confirm diagnosis
4. Rule out neck nerve compression causing symptoms

Anatomy of Carpal Tunnel:
9 tendons and the median nerve pass through the tunnel from the forearm to the hand.  Increased pressure in the tunnel form inflammation in one or many of the tendons irritate the median nerve.
see also anatomy pictures:

Brachial Plexus

Head/Neck Arteries

Neck Lymphatic System

Head/Neck Muscles

Neck Muscles view 2

Neck Nerve Plexus

Treatment Goals:

• treat triggerpoints in forearms especially flexors and extensors
• correct postural deviations in shoulder, forearm, wrist
• Stretching to lengthen tendons
• icing
• strengthening after acute stage ( the tendons are usually to weak to do the repetitive work so they become inflamed)

Other helpful therapies: Naturopathy -B vitamin supplementation, Chiropractic, Physical Therapy

There are still many physicians who don’t believe in using massage, physical therapy, chiropractic and acupuncture for such conditions.  I have seen many cases of carpal tunnel resolve using massage and other methods.  Surgery is often done as a last resort after trying everything else.  Carpal tunnel syndrome can be treated successfully without surgery.

Prevention of Carpal Tunnel syndrome includes stretching regularly, strengthening the forearm, neck, shoulder and back muscles, learning about proper postural alignment, getting regular massage sessions, proper self care including diet, sleep, stress reduction.

Resources:

Assess & Address Carpal Tunnel Syndrome
by Whitney Lowe

Median Nerve Compression Pathologies By Whitney Lowe, LMT, NCTMB

Carpal tunnel syndrome Fact sheet : Published by BUPA’s Health Information Team
June 2003

Carpal Tunnel Syndrome Prescription for Relief By Michael Young, NCTMB

Touch Research Institute:

“Carpal Tunnel Syndrome “A daily self-massage for stretching tendons alleviated pain and increased nerve conducting velocity following one month in adults with carpal tunnel syndrome (CTS).
Field, T.., Diego, M., Cullen, C., Hartsorn, K., Gruskin, A., Hernandez-Reif, M. and Sunshine, W. (2004). Carpal Tunnel Syndrome symptons are lessened fallowing massage therapy. Journal of Bodywork and Movement Therapies,8, 9-14.”

Challenging the Traditional Diagnosis of Carpal Tunnel Syndrome By James Waslaski – Massage Today